Reliability of Pelvic Floor Muscle Assessment with Transabdominal Ultrasound in Young Nulliparous Women

The effect of high-intensity TESLA stimulation (HITS) therapy on pelvic floor electromyography (EMG) and potential clinical implications for use

BACKGROUND

Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can significantly impact quality of life for affected women. The compliance and tolerability of strategies such as physiotherapy with or without electrical stimulation is variable. Non-invasive, extracorporeal treatments such as High Intensity Tesla (HITS) therapy have become increasingly promoted as an alternative to physiotherapy but the evidence to support HITSTM is limited.

OBJECTIVES

To assess the impact of a short course of 8-10 sessions using HITSTM on Electromyographic (EMG) activity of pelvic floor muscles (PFMs) and participant's satisfaction using the HITSTM chair.

STUDY DESIGN

Participants utilised the HITSTM chair, twice a week for 30 min over 4-to-6-weeks (8-10 sessions in total). For each session, the first 10 min was delivered at a frequency of 10 Hz followed by 10 min at 23 Hz and lastly 10 mins at 35 Hz as this has been shown to be optimal for improving PFM strength. Prospective electromyography measurements at rest, maximum voluntary contraction and endurance of nine volunteers were recorded using the MAPLe® device at baseline and after completion of treatments.

RESULTS

Paired t-test showed statistically significant differences for both endurance and maximum voluntary contraction of PFMs when compared to EMG measurements prior to interventions (p = 0.0003 and p = 0.0002 respectively). Hence, this study demonstrated that all participants had improvement in their EMG muscle activity.

CONCLUSION

The HITS chair can effectively increase PFM strength and may be a useful outpatient treatment to manage patients with pelvic floor dysfunction such as SUI and POP.

Adolescent idiopathic scoliosis causes pelvic floor dysfunction: A cross-sectional study

BackgroundScoliosis is a complex three-dimensional deformity of the spine and causes spinal misalignment and pelvic structure changes.ObjectiveThis cross-sectional study was designed to investigate the relationship between postural deviation, scoliosis angle and pelvic floor dysfunctions in individuals with adolescent idiopathic scoliosis (AIS).MethodsTwelve AIS aged between 12 and 18 years were included in the study. Standard scoliosis radiography was used for Cobb angle measurement. The posture screen mobile (PSM) application was used for determining postural deviation, and a real-time ultrasound image was obtained for pelvic floor muscle activity. The pelvic floor distress inventory was used for the evaluation of pelvic floor dysfunctions.ResultsThere was a significant negative correlation between bladder base elevation and the following variables, including thoracic and lumbar Cobb angles (r = -0.640, p < 0.05; r = -0.779, p < 0.05), Dysfunctional Voiding Scoring System (DVSS) (r = -0.753, p < 0.05), Pelvic Floor Distress Inventory (PFDI) (r = -0.722, p < 0.05) and Urinary Distress Inventory (UDI) (r = -0.585, p < 0.05). The apical shift in the frontal plane was found to be positively correlated with DVSS (r = 0.701, p < 0.05), UDI (r = 0.641, p < 0.05) and PFDI-20 (r = 0.628, p < 0.05) and negatively correlated with bladder base elevation (r = -0,615, p < 0.05). The average pelvic shift in frontal plan was found to be positively correlated with DVSS (r = 0.810, p < 0.05), PFDI-20 (r = 0.722, p < 0.05), Pelvic Organ Prolapse Distress Inventory (POPDI) and UDI (r = 0.626, p < 0.05) and negatively correlated with bladder base elevation (r = -0.626, p < 0.05).ConclusionScoliosis negatively affects pelvic floor muscle activity, and pelvic floor functions, resulting in urinary dysfunction. Pelvic floor assessment may be added to the evaluation process in patients with AIS.

A Single Session of Temporomandibular Joint Soft Tissue Therapy and Its Effect on Pelvic Floor Muscles Activity in Women-A Randomized Controlled Trial

Background/Objectives: Pelvic floor muscles (PFM) play a vital role in the proper functioning of the pelvic and abdominal organs. The PFM are structurally connected to other areas of the body, forming part of the deep front line. Due to its course, this line connects the PFM with the temporomandibular joint (TMJ). The aim of the study was to evaluate the impact of a single 15-minute soft tissue therapy session in the TMJ on the activity of the PFM. Methods: A total of 47 nulliparous women aged 20-29 years old diagnosed with myofascial pain in the TMJ area were included in the study. PFM were assessed using the Noraxon Ultium device and a vaginal probe, utilizing the surface electromyography (sEMG) method. The sEMG signal was processed with MyoResearch XP software version 1.0. Additionally, bladder floor displacement during PFM contractions was evaluated using an ultrasound imaging device set in B-mode (LOGIQ P7/P9). Results: In the experimental group, following the applied soft tissue therapy, a significant decrease in resting PFM activity between maximal contractions was observed (p < 0.05). The resting PFM activity assessed in the final phase of the measurement protocol was also significantly lower (p < 0.05). During endurance contractions in the experimental group, after the therapy, an 18.05% increase in PFM tension amplitude was noted, although this change was not statistically significant. In the control group, a decrease in amplitude was observed during the second assessment in this phase of the test. Conclusions: A single session of soft tissue therapy in the TMJ area may enhance the ability of the pelvic floor muscles to relax and contribute to improved muscle function by increasing their activation levels during submaximal contractions.

Ultrasound imaging of core muscles activity in multiparous women with vaginal laxity: a cross-sectional study

Vaginal laxity (VL) is a common condition among multiparous women, especially those who have delivered vaginally. Since pelvic floor muscles (PFMs) work synergistically with other core muscles, physical therapy protocols that aim to treat VL should train the PFMs in combination with other core muscles. To investigate the activity of core muscles in multiparous women with and without VL, and its relation to sexual function. An observational, cross-sectional study. The study included 100 multiparous women, who were divided into two groups according to their scores on the vaginal laxity questionnaire (VLQ). Women who scored between 1 and 3 on the VLQ were categorized as having VL (n = 48), while those who scored between 5 and 7 were placed in the control group (n = 52). The primary outcomes were PFM displacement, diaphragmatic excursion, transversus abdominis activation ratio, and lumbar multifidus thickness measured by ultrasound imaging. The secondary outcome was sexual functioning, evaluated using the Arabic female sexual function index (ArFSFI). The VL group had significantly lower PFM displacement (mean difference (MD) - 0.42; 95% confidence interval (CI) - 0.49 to - 0.33; p = 0.001), diaphragmatic excursion (MD - 2.75; 95% CI - 2.95 to - 2.55; p = 0.001), lumbar multifidus thickness (MD - 10.08; 95% CI - 14.32 to - 5.82; p = 0.02), and ArFSFI scores (MD - 9.2; 95% CI - 10.59 to - 7.81; p = 0.001) in comparison to the control group (p < 0.05). Nevertheless, the transversus abdominis activation ratio demonstrated no significant difference between the two groups (MD 0.06; 95% CI - 0.05 to 0.17; p = 0.33). Multiparous women with VL had significantly lower PFM displacement, diaphragmatic excursion, lumbar multifidus thickness, and sexual function index scores than women in the control group. The only exception was transversus abdominis activation, which did not differ significantly between the VL and control groups.