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

Does pelvic floor and abdominal muscle function and the synergy between these muscles change in young and older women with urinary incontinence?

AIM

The aim of this study was to examine the synergistic relationship between the pelvic floor muscles (PFM) and abdominal muscles in older women with urinary incontinence (UI). Our secondary aim is to compare PFM and abdominal muscle functions and synergistic relationship according to incontinence type in younger and older women.

MATERIAL AND METHODS

This cross-sectional study was conducted with 46 older and 31 younger women. Urogenital Distress Inventory (UDI-6) and Over Active Bladder-Validated 8 (OAB-V8) were used to evaluate the severity of participants' urinary symptoms, and the Incontinence Impact Questionnaire (IIQ-7) was used to evaluate the quality of life related to the symptoms. PFM function was evaluated by superficial electromyography (EMG) and digital palpation; abdominal muscle function was evaluated by EMG.

RESULTS

The average ages of the participants in the younger and old female groups were 49.74 ± 7.25 years and 74.87 ± 5.41 years, respectively. PFM endurance (p = 0.005), number of fast repetitions (p = 0.073) and work average value of the participants in the older women group were found to be lower than those in the younger women group (p = 0.002). In the group of older women with mixed incontinence (MUI), PFM endurance (p = 0.022), PFM (p = 0.002), Transversus abdominis (TrA) (p = 0.007), rectus abdominis (RA) (p = 0.015), internal oblique (IO)(p = 0.002) and external oblique (EO) abdominal muscles (p = 0.001) work average values ​​were significantly lower. In the younger women group with urge incontinence (UUI), the PFM work average value was higher than in the older women group (p = 0.021). During PFM contraction, a moderate positive correlation was found between PFM and RA (r = 0.498, p = 0.001), IO (r = 0.405, p = 0.006) and EO (r = 0.442, p = 0.002) in the older women group.

CONCLUSION

This study showed that older women with UI demonstrated reduced PFM endurance, fewer fast PFM contractions, and lower PFM and abdominal muscle activity compared to younger women with UI. A positive association was observed between the PFM and the RA, IO, and EO muscles specifically in older women with UI. Importantly, our findings indicate that both PFM and abdominal muscle function decline with age in women, irrespective of UI status, leading to a worsening of related symptoms. Consequently, we recommend the implementation of preventive physiotherapy and rehabilitation programs beginning at a young age to preserve and optimize PFM and abdominal muscle function in women.

Relationship Between Abdominal Muscle and Pelvic Floor Muscle Activation in Elderly Individuals with Urinary Incontinence

INTRODUCTION AND HYPOTHESIS

The aim of our study is to examine the relationship between abdominal muscles and pelvic floor muscles (PFM) activation in elderly individuals with urinary incontinence (UI).

METHODS

This cross-sectional study was conducted with 43 elderly individuals (27 women, 16 men) with UI in a nursing home. Superficial electromyography (EMG) was used to assess the contraction and relaxation activities of the PFM and abdominal muscles (rectus abdominis, transversus abdominis, internal obliques, external obliques). The Overactive Bladder Awareness Questionnaire (OAB-V8) and the Urogenital Distress Inventory Short Form (UDI-6) were used to assess incontinence symptoms and severity. The Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI) was used to evaluate the level of self-efficacy. Quality of life was assessed using the Incontinence Impact Questionnaire Short Form (IIQ-7) and the Incontinence Quality of Life Scale (I-QOL). Chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation analysis were used for statistical analysis.

RESULTS

A moderate positive correlation was found between PFM work MVC and RA work MVC (r 0.540, p 0.001), IO work MVC (r 0.485, p 0.002), and RA rest MVC (r 0.441, p 0.006). When analyzed by gender, significant differences were found in the average activity of RA contraction, average activity of EO contraction, and normalized MVC values (p 0.035, p 0.048, p 0.001). When analyzed by incontinence type, significant differences were found in the TA relaxation MVC and average activity of IO contraction (p 0.006, p 0.011).

CONCLUSIONS

There is a relationship between the functions of PFM and abdominal muscles in individuals with UI. Additionally, EMG data during both abdominal and PFM contractions are higher in men at this age. Incontinence type may affect abdominal muscle function.

Does combining two evidence-based exercise programs in elderly people with incontinence have a triple effect on incontinence symptoms, balance and functional status?

BACKGROUND

Improving pelvic floor muscle training (PFMT), balance and functional activity is recommended in the treatment of urinary incontinence (UI) in the elderly people. The aim of this study is to examine whether PFMT combined with Otago exercises is effective on symptoms, balance and functional status in elderly people with UI compared to PFMT alone.

METHODS

This study is an assessor-blinded, randomized controlled trial. Participants with UI aged 65 and over living in a nursing home were randomly assigned to the intervention (IG) and control groups (CG). The intervention group attended an exercise program that included Otago exercises combined with PFMT. The control group was included in the PFMT program with different positions. The duration of exercise for both groups was 45-60 min per session three times a week for 12 weeks. UI symptoms and severity (Pelvic Floor Distress Inventory-20, bladder diary), PFM muscle function (superficial electromyography), balance (Berg Balance Scale), functional status (Senior Fitness Test) and fear of falling (Falls Efficacy Scale) were measured at baseline and after the intervention.

RESULTS

The median age of the IG (n: 22) and CG (n: 21) was 73.5 and 77 years, respectively. At baseline and after the intervention within the group, a significant improvement was observed in the PTDE-20 score (IG and CG, p: 0.00) and the 2-min step test in the IG (p: 0.02) and CG (p: 0.01). A significant decrease was found in the 2.45 m get up-and-go test, PFM work average onset, and PFM rest MVC EMG values (p: 0.01, p: 0.01, p: 0.00) in the IG. The PFM rest average value decreased (p: 0.04) in the CG.

CONCLUSION

The findings of this study show that combining PFMT with Otago exercises, two evidence-based interventions, is beneficial for effectively treating incontinence symptoms, balance and functional status in elderly people. Thus, a triple effect can be achieved with a single exercise training in the same treatment session and for the same duration.

CLINICAL TRIAL NUMBER

Clinical trial number: NCT06331039.

Relationship Between A Body Shape Index and Self-Reported Stress Urinary Incontinence Among US Women: A Cross-Sectional Analysis

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence (SUI) is common among women, but its link with A Body Shape Index (ABSI) is not well understood. This study investigates the association between ABSI and SUI risk in women, exploring variations across different subgroups.

METHODS

Data from National Health and Nutrition Examination Survey (2001-2020) were analyzed. A weighted multivariable logistic regression was performed to examine the relationship between ABSI and SUI risk, calculating odds ratios and 95% confidence intervals. A restricted cubic spline (RCS) analysis was used to assess any nonlinear associations. Subgroup analyses and interaction tests were conducted to explore the influence of factors on the ABSI-SUI relationship. Sensitivity analyses were also performed to ensure the robustness of the findings.

RESULTS

The analysis, after adjusting for potential confounders, showed a significant association between ABSI and SUI risk (p < 0.001). The RCS analysis indicated a nonlinear relationship (p for nonlinear = 0.02) with a turning point at an ABSI of 0.081. Subgroup analyses revealed that the association between ABSI and SUI was stronger in women with lower BMI, non-Mexican ethnicity, and those without hypertension (p for interaction < 0.05). Sensitivity analyses confirmed the consistency of these findings, supporting their robustness.

CONCLUSION

Higher ABSI is associated with an increased risk of SUI in US women, particularly in specific subgroups. This suggests that ABSI could be a valuable measure for identifying women at higher risk of SUI.

Do pelvic floor muscle function parameters differ in women according to continence status? A systematic review

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.

Analysis of multisite surface electromyography characteristics of pelvic floor muscles in postpartum patients with diastasis recti abdominis

AIM

To explore the electrophysiological characteristics of the independent muscles in the pelvic floor muscle (PFM) group of postpartum women with diastasis recti abdominis (DRA) and analyze the correlation between the rectus abdominis interval and PFM function.

METHODS

A total of 133 women who underwent postpartum re-examination from August 2021 to July 2022 were collected. The participants were divided into DRA and control groups based on the occurrence of DRA on ultrasonography. General data of the participants were collected, and the multisite surface electromyography (sEMG) assessment of the PFMs was performed using a intravaginal novel airbag-type stretchable electrode array device developed by the team. The sEMG characteristics of the different PFMs in the two groups were compared, and the correlation between the maximum rectus abdominis interval and the sEMG parameters of different PFMs was analyzed.

RESULTS

There were no differences in the baseline demographics and incidence of pelvic floor dysfunction between the two groups (p > 0.05). The mean amplitude of vaginal sphincter endurance contraction in the DRA group was significantly lower than that in the control group (28.44 ± 15.59 vs. 22.03 [12.22, 28.00], p < 0.05). Spearman's rank correlation analysis showed a weak negative correlation between the maximum rectus abdominis interval and the endurance contraction mean amplitude of the urethral and external anal sphincters (r = -0.173, -0.217, p < 0.05).

CONCLUSIONS

Patients with DRA had weakened PFM endurance, and there was a weak negative correlation between the maximum rectus abdominis interval and the endurance contraction mean amplitude of the PFM.

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.

Women with Chronic Pelvic Pain Demonstrate Increased Lumbopelvic Muscle Stiffness Compared to Asymptomatic Controls

Background: Although lumbopelvic muscle stiffness is commonly clinically assessed in women with chronic pelvic pain (CPP), it has not been objectively quantified in this population, and its association with other pain-related impairments has not yet been established. Objective: To compare superficial lumbopelvic muscle stiffness in women with and without CPP. In addition, pressure pain threshold (PPT) was compared between groups and the associations between muscle stiffness and PPT were assessed in women with CPP. Study Design: Case-control. Methods: Muscle stiffness and PPT of 11 lumbopelvic muscles were assessed in 149 women with CPP and 48 asymptomatic women. Subjective outcome measures, including pelvic floor function, health history, and psychosocial outcomes, were collected before muscle stiffness and PPT measurements. Analysis of covariance was used to compare muscle stiffness differences between groups, and independent t-tests were used to compare PPT between groups. Associations between measurements of PPT and muscle stiffness were calculated using correlation analysis. Results: Five of the 11 muscles measured were significantly stiffer in women with CPP than those without CPP (p < 0.05). PPT was significantly decreased in all muscles measured in women with CPP; however, there was not a significant association between muscle stiffness and PPT in women with CPP. Conclusion: The study identified the abdominal lumbopelvic muscles that have increased stiffness in women with CPP compared to asymptomatic women. In addition, muscle stiffness and PPT are two distinct impairments within this population. The results suggest that women with CPP have peripheral muscle impairments, which may be addressed without intravaginal or intrarectal intervention. Clinical Trial Registration: NCT04851730.

Assessment of menopausal symptoms with changing hormone milieus in different menopausal transitional stages

The present cross-sectional study is an attempt to evaluate menopausal symptoms with changing hormone milieus among women of different menopausal transitional stages. Out of all the symptoms, sexual dysfunction was the most commonly occurring symptom. Results of the correspondence analysis exhibited a significant association of symptoms like 'feeling unhappy', 'feeling dizzy', 'parts of body feeling numb' and 'muscle & joint pain' with late postmenopausal stage. Therefore, the assessment of menopausal health of women in rural settings of developing countries like India is of considerable significance for promoting their post reproductive health as well as for enhancing their quality of life.

Are clinically recommended pelvic floor muscle relaxation positions really efficient for muscle relaxation?

INTRODUCTION AND HYPOTHESIS

Various positions for pelvic floor muscle (PFM) relaxation are recommended during PFM training in physiotherapy clinics. To our knowledge, there is no study addressing the most effective position for PFM and abdominal muscle relaxation. Therefore, the current study aimed to investigate the effect of different relaxation positions on PFM and abdominal muscle functions in women with urinary incontinence (UI).

METHODS

Sixty-seven women diagnosed with UI were enrolled in the study. The type, frequency, and amount of UI were assessed with the International Incontinence Questionnaire-Short Form and bladder diary. Superficial electromyography was used to assess PFM and abdominal muscle functions during three relaxation positions: modified butterfly pose (P1), modified child pose (P2), and modified deep squat with block (P3). Friedman variance analyses and Wilcoxon signed rank test with Bonferroni corrections were used to evaluate the difference between positions.

RESULTS

The most efficient position for PFM relaxation was P1 and followed by P3 and P2, respectively. The order was also the same for abdominal muscles (p < 0.001), P1 > P3 > P2. The rectus abdominis (RA) was the most affected muscle during PFM relaxation. The extent of relaxation of RA muscle increased as the extent of PFM relaxation increased (r = 0.298, p = 0.016). No difference was found between different types of UI during the same position in terms of PFM relaxation extents (p > 0.05).

CONCLUSIONS

Efficient PFM relaxation is maintained during positions recommended in physiotherapy clinics. The extent of PFM and abdominal muscle relaxation varies according to the positions.

Benefits of applying virtual reality in pelvic movement training through a Wii Fit: a randomized controlled trial

BACKGROUND

Pelvic movement training has become compulsory for part of medical students. An increasing amount of research has focused on the influence of virtual reality (VR) on learning effectiveness. However, its application to pelvic floor muscles or pelvic movement training is still in its infancy. We compared the effectiveness of conventional pelvic movement training with or without VR-assisted pelvic movement training for student learning.

METHODS

We recruited 44 university students (16 male and 28 female participants; average age = 19.7 ± 0.31 years) who had not previously received pelvic movement education or training. The participants were randomly assigned into traditional and experimental groups to acquire pelvic movements and relevant knowledge. The traditional group received conventional classes (about 15 min), whereas the experimental group received both conventional classes and VR-assisted teaching (additional VR session took approximately 25-45 min depending on the speed of movement of each participant). The participants were asked to control the trajectory of the centre of pressure on the Wii Fit balance board and build-in games to learn pelvic movements. We conducted evaluations before, immediately after, and 2 weeks after the experiment, based on the scores of written and practical examinations. The experimental group was also asked to complete a questionnaire during the posttest.

RESULTS

We carried out two-way repeated measures ANOVA and discovered that the written examination scores indicated a significant Time × Group interaction (p=0.015). In each group, the written and practical examinations in the posttest and follow-up test exhibited significantly improved results compared with the baseline value (p <0.001, except for traditional group of written exam in follow up test vs. baseline p=0.001). The written examination in the follow-up test did not decline significantly compared with those in the posttest, but the practical examination in the follow-up test was decline significantly compared with those in the posttest (p=0.033). The experimental group had superior overall performance in the practical examinations than the traditional group (experimental group: mean = 76.27, 95% confidence level [CI] = 70.84-81.71; traditional group: mean = 64.21, 95% CI = 58.78-69.65). No significant difference in the written examination between two groups. The percentage for agreement ratio on the usefulness, ease of use, users' intention to continue using the VR-assisted teaching is high (95.5-100%).

CONCLUSIONS

The results of this study suggested that conventional and conventional + VR teaching were both effective. However, the incorporation of VR stimulated learning motivation and facilitated precise performance of pelvic movements. It is recommended that pelvic floor muscles training could be supplemented with VR or games to increase students' motivation and understanding how to perform pelvic movements.

Assessment of the Elastographic and Electromyographic of Pelvic Floor Muscles in Postmenopausal Women with Stress Urinary Incontinence Symptoms

Background. Shear wave elastography is an effective method for studying the condition of various musculoskeletal soft tissues. The primary aim of this study was the objective elastographic and electromyographic assessment of the pelvic floor during the rest and contraction of the pelvic floor muscles (PFM) in postmenopausal women. Methods. This was a prospective observational study that was carried out at the University Hospital in Wroclaw, Poland, between January 2017 and December 2019. Patients. The target group of the study included postmenopausal women with stress urinary incontinence. The primary outcomes were the features of the elastographic assessment of the pelvic floor during rest and contraction of the PFM obtained using shear wave elastography. Results. Based on the inclusion and exclusion criteria for the study, 14 patients took part in the measurements. There was a significant difference between the elastographic assessment of the pelvic floor during rest and contraction of the PFM at all locations in front of the urethra. No statistically significant correlation was found between the results of elastography and the bioelectrical activity of PFM. Conclusion. The elasticity of the periurethral structures is higher during active pelvic floor muscle contraction than at rest, it seems that shear wave elastography is an effective test that objectively assesses the strength of PFM contraction.

Techniques for registration of myoelectric activity of women's pelvic floor muscles: a scoping review protocol

OBJECTIVE

The objective of this review is to identify the most frequently used protocols for analyzing the myoelectric activity of the pelvic floor muscles during surface electromyography in women aged 18 years or older.

INTRODUCTION

Surface electromyography is normally used in assessment and treatment for research purposes when it is intended to quantitatively measure the electrophysiological behavior of the neuromuscular system. However, although there are internationally standardized, non-invasive assessment protocols for most muscle groups, there is no consensus for pelvic floor muscles, which makes it difficult to standardize in scientific research and clinical applicability.

INCLUSION CRITERIA

Studies that explore registration protocols and filtering parameters of surface electromyographic signals in women aged over 18 years old with or without pelvic floor dysfunction will be considered. Studies encompassing either electromyographic biofeedback as a treatment resource only or electroneuromyography (needle electrode) will be excluded.

METHODS

Primary studies published in the previous 10 years in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and Cochrane Central databases will be included. The search will encompass descriptors registered in MeSH. The identified articles will be assessed for eligibility by two independent reviewers in three stages: evaluation by title, abstract, and full text. If there is any disagreement, a third reviewer will be consulted. Data will be extracted and organized in standardized spreadsheets. The results will be assigned to categories in order to facilitate the organization of a protocol with the most commonly used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles.

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.

Deleterious effects of gestational diabetes mellitus on the characteristics of the rectus abdominis muscle associated with pregnancy-specific urinary incontinence

AIMS

To evaluate the effects of gestational diabetes mellitus (GDM) on the structural characteristics of the rectus abdominis muscle (RAM) and its indirect effects on pregnancy-specific urinary incontinence (PSUI).

METHODS

A total of 92 pregnant women were divided into four groups, according to their clinical conditions: non-GDM continent, non-GDM associated PSUI, GDM continent and GDM associated PSUI. The muscle morphometry (histochemistry and immunohistochemistry) for the fiber types and collagen fiber distribution, the ultrastructural analysis (transmission electron microscopy), the protein expression of fiber types and calcium signaling (Western blotting), and the content of types I and III collagen fiber (ELISA) in RAM collected at delivery were assessed.

RESULTS

The GDM groups presented a significantly increased number of slow fibers and slow-twitch oxidative fiber expression; decreased fiber area, number of fast fibers, and area of collagen; an increase in central nuclei; ultrastructural alterations with focal lesion areas such as myeloid structures, sarcomere disorganization, and mitochondrial alteration. The PSUI groups presented a considerable decrease in types I and III collagen contents and the localization of collagen fiber.

CONCLUSIONS

Our data reveal that GDM causes morphological, biochemical and physiological changes in the RAM, and this might predispose women to PSUI.

Efficacy of bio-assisted pelvic floor muscle training in women with pelvic floor dysfunction

OBJECTIVES

To evaluate the efficacy of 12-week pelvic floor muscle training (PFMT) using bio-assisted surface electromyography (EMG) feedback in women with complex pelvic floor dysfunction (PFD); to further differentiate the effect of exercise adherence from the biofeedback per se; and to assess and compare the severities of overactive bladder (OAB) symptoms, stress urinary incontinence (SUI), and stage of prolapse with the women's perception of symptom cure or improvement following the program.

STUDY DESIGN

This prospective observational study was conducted between December 2015 and November 2018 at a medical center in Taiwan. It included 83 women with PFD, manifesting solely as either OAB or SUI with (group 1) or without (group 2) concomitant stages I and II pelvic organ prolapse (POP). All women underwent a 12-week bio-assisted PFMT. The main outcome was the electromyographic activity of the pelvic floor muscles (PFMs). The severities of OAB symptoms, SUI, and stage of POP were assessed both subjectively and objectively before and after the intervention.

RESULTS

A notable improvement of PFM function was identified after 12 weeks of training in all women with PFD. The number of effective PFM contractions achieved during bio-assisted PFMT was positively correlated with the improvement of PFM function in both groups of women in different body positions, except in the standing position in group 2. Exercise adherence, however, had no significant impact on the efficacy of the training. There was a significant improvement over time and high consistency between subjective and objective improvements of OAB symptoms and SUI severity after the completion of PFMT. Nonetheless, only the Ba point of the POP-Quantification system in women with POP showed a significant improvement after the intervention.

CONCLUSION

PFMT using surface EMG biofeedback significantly improves PFM function in women with complex PFD, and thus, has a significant therapeutic effect on OAB, SUI, and bladder prolapse.

Assessment of the Short-Term Effects after High-Inductive Electromagnetic Stimulation of Pelvic Floor Muscles: A Randomized, Sham-Controlled Study

Background: Physiotherapy should be performed by patients with stress or mixed urinary incontinence (SUI and MUI) to increase the strength and endurance of the pelvic floor muscles (PFMs). A method that can positively affect the pelvic floor is stimulation with high-inductive electromagnetic stimulation (HIES). The aim of the study was to evaluate the PFMs after the application of HIES in women with SUI and MUI by using surface electromyography (sEMG). Methods: This was a prospective, randomized, single-blind study with a sham intervention group. The participants were randomly assigned to the HIES group or sham group. The outcomes were features of the bioelectrical PFM activity assessed using sEMG and endovaginal probes. A single-session intervention in the HIES group included 20 min of HIES with an electromagnetic induction intensity of 2.5 T. Results: In the HIES group, there was a statistically significant difference in the PFM sEMG activity during “contractions” (p < 0.001) and “quick flicks” (p = 0.005). In the intergroup comparison, higher PFM sEMG activity after the intervention (“contraction”) was observed in the HIES group than in the sham group (after: p = 0.047; 1 h after: p = 0.017). Conclusions: The assessed HIES method seems effective for SUI and MUI patients in the short term and shows an advantage over the sham intervention in the assessment of PFM contractions.

A Novel Rehabilitative Protocol in the Treatment of Mixed Urinary Incontinence in Women: The Effects of Focused Mechano-Acoustic Vibration

Dysfunctions of the pelvic floor related to mixed urinary incontinence in women are pathologies extremely limiting for patients bodily and psychosocial conditions, altering their quality of life. The aim of this study was to determine the effects of focal mechanical vibrations in mixed urinary incontinence. In this retrospective observational case-control study, 65 patients were randomized and divided into 2 groups: treatment group by focal mechanical vibrations (VISS-10 sessions) (N = 33) and a control group in waiting list (N = 32). Also, both groups received home-based postural ergonomic instructions to reinforce pelvic floor. Data were collected at T0 (baseline), T1 (end of treatment), and T2 (follow-up = after 1 month): rheological muscle parameters were assessed by MyotonPRO respect to evaluate the gluteus maximus muscle. Then, to measure the general disability of the pelvic floor and the impact of urogenital problems on daily activities the Pelvic Floor Disability Index (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were used. Groups were matched perfectly before treatment for age (58.20 ± 4.37 vs. 58.73 ± 5.19) and BMI (26.15 ± 2.22 vs. 25.85 ± 2.11); for the two-way ANOVA analysis, a difference in gluteus variables over time and between groups except for GMDR (group p-value = 0.60) was showed. The two-way ANOVA shows statistically significant effects of treatment and time for PDFI-20 and PFIQ-7 (p-value <0.001). An improvement in incontinence symptoms and quality of life in the PDFI-20 and PFIQ-7 scores were reported and VISS may favor muscles stiffness for exercises by improving the normalization of basal tone. Our results were encouraging and suggested the use of focal mechanical vibration as a novel tool for treating mix urinary incontinence in women to complete and help the rehabilitative therapeutic protocol.

Investigation of Electromyographic Activity of Pelvic Floor Muscles in Different Body Positions to Prevent Urinary Incontinence

Background

This study aimed to determine whether trunk stability muscles co-contract with body position as a factor of pelvic floor muscle (PFM) activity.

Material/Methods

Sixty-one healthy adults without pelvic floor dysfunction were examined for pelvic floor and trunk stability muscle activity in 4 body positions (ankle dorsiflexion and plantar flexion in standing position, and ankle dorsiflexion and plantar flexion in long sitting position). The activities of the PFMs via anal/vaginal probes, internal oblique (IO), multifidus (MF), tibialis anterior, and gastrocnemius muscles were measured by surface electromyography. Three-dimensional motion analysis measured the movement of the pelvis in real time according to the change in body position.

Results

There was a significant increase in PFM activity from the ankle neutral position while standing for both ankle dorsiflexion and plantar flexion in standing position (p<0.05). In maximal contraction of PFM in the standing position, IO and MF were found to co-activate (p<0.05).

Conclusions

In standing position, the ankle dorsiflexion and plantar flexion positions activated PFMs, which was found to co-activate with trunk stability muscles. Pelvic floor training programs based on the results of this study may be helpful in patients with incontinence.

Sexual Dysfunction in Menopausal Women

INTRODUCTION

Hormone-related changes in menopause may negatively affect sexual function.

AIM

The primary aim of this study was to evaluate sexual functioning in Polish women with the Female Sexual Function Index (FSFI). The secondary aim was to evaluate the major factors affecting sexual functions in middle-aged Polish women.

METHODS

The Menopause Rating Scale was used to assess the menopausal symptoms. The Polish translation of the FSFI was used to assess sexual function.

OUTCOMES

69.73% of respondents had sexual dysfunction according to FSFI (FSFI score ≤ 26.55).

RESULTS

80.61% of women experienced menopausal symptoms during the 4-week period of study. Psychological and urogenital symptoms were the most frequently reported among all the women enrolled in the study (78.23% and 77.21%). Sexual problems were observed in women who did not use hormone therapy (β = 0.09, t = -1.97, P = .048) and showed no somatic symptoms (β = 0.03, t = 2.95, P = .002).

CLINICAL IMPLICATIONS

It is important for health care providers to ask women about this problem and understand the factors that may influence sexual problems in menopause.

STRENGTHS & LIMITATIONS

A validated survey tool was used. The limitation was selection of participants in the clinical setting and sample population size.

CONCLUSION

Sexual problems were much more common in women who did not use hormone therapy and showed no somatic symptoms. Dąbrowska-Galas M, Dąbrowska J, Michalski B. Prevalence and Associated Risk Factors of Sexual Problems Among Polish Middle-Aged Women. Sex Med 2019;7:472-479.

Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis

There is an ongoing discussion regarding abdominal muscle (AbM) and pelvic floor muscle (PFM) synergism. Therefore, this study aimed to investigate the cocontraction between AbMs and PFMs in women with or without pelvic floor dysfunction (PFD). The following databases were searched up to December 21, 2018: MEDLINE, EMBASE, LILACS, PEDro and CENTRAL. We included any study that assessed the cocontraction between PFMs and AbMs in women with and without PFD. Two reviewers independently screened eligible articles and extracted data. The outcomes were extracted and analyzed as continuous variables with random effect models. Twenty studies were included. A meta-analysis did not show differences in women with and without PFD. However, a sensitivity analysis suggested cocontraction of the transversus abdominis (TrA) during PFM contraction in healthy women (standardized mean difference (SMD) -1.02 [95% confidence interval (CI) -1.90 to -0.14], P=0.02; I2= not applicable; very low quality of evidence). Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% CI 0.27 to 1.94], P=0.01; I2= not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], P<0.0001; I2 = not applicable; very low quality of evidence). Increased cocontraction of the TrA may be associated with maximal contraction of PFMs in women without PFD. On the other hand, there is likely an increased cocontraction with the OI and OE in women with PFD.

The relation of the pelvis and the perineal function in incontinent women: A neglected subject

AIMS

To Compare the angular parameters of the pelvis of continents and incontinent women and to correlate them with the electrical activity and the function of the pelvic floor muscles.

METHODS

Cross-sectional study. Incontinent and continent women, aged between 18 and 59 years. The anatomical points were marked following the SAPO protocols, the photographic records were made and analyzed through the SAPO Software. The evaluation of the function of the MPF was performed by bidigital vaginal palpation, using the PERFECT scheme. Surface electromyographic analysis was performed in dorsal decubitus and orthostasis.

RESULTS

The sample consisted of 40 women, 20 with SUI (IG) and 20 continents (CG), matched by age. The mean age in the CG was 43.5 years (SD 8.4), while in the IG it was 47.1 years (SD 7.8) (P = 0.16). The pelvic angle in the CG presented a mean of -14.3 ± 4.6 and the IG -16.6 ± 4.4 (P = 0.02). When compared to normality, IG presented an accentuation of anterior slope in both analyzed views (P = 0.01). There was a moderate correlation in the IG between the electrical activity of the basal pelvis in orthostasis and the anterior pelvic tilt angles in the right lateral views r = 0.51 (P = 0.02) and left lateral r = 0.46 (P = 0.04). No correlation was found in the CG.

CONCLUSIONS

In the present sample, incontinent women have a greater anterior slope of the pelvis, and the greater the degree of anterior slope, the greater the electrical activity of the PFM, during rest, and in orthostasis.

Morphological changes in rat rectus abdominis muscle induced by diabetes and pregnancy

The urethral muscle of diabetic pregnant rats is affected by long-term mild diabetes and short-term severe diabetes, which plays a crucial role in the pathogenesis of pelvic floor disorders. We hypothesized that muscles outside the pelvis are subject to similar changes. The current study aimed at analyzing the effects of long-term mild and short-term severe diabetes on the structure and ultrastructure of fiber muscles and collagen in rats' rectus abdominis (RA) muscle. Therefore, the RA muscle of virgin, pregnant, long-term mild diabetic, short-term severe diabetic, long-term mild diabetic pregnant and short-term severe diabetic pregnant 3-month-old Wistar rats were collected. The structure was analyzed by picrosirius red staining, immunohistochemistry for fast and slow muscle fibers and transmission electron microscopy. We investigated two levels of STZ- induced diabetes: long-term mild diabetes (blood glucose level: 120–200 mg/dL) and short-term severe diabetes (blood glucose level >300 mg/dL). Long-term mild diabetic pregnant and short-term severe diabetic pregnant rats had decreased fast fibers and increased slow fibers, disrupted areas of sarcomere, intermyofibrillar mitochondria and myelin figures in the RA muscle. Both groups enabled us to analyze the specific influence of pregnancy, separately from diabetes. The current study demonstrated that diabetes and pregnancy induced intramuscular transformation and reorganization of RA muscle with a switch of fiber type adjusting their architecture according to intensity and duration of hyperglycemic insult within pregnancy.