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Sun ZJ, Tian Z, Xu T, Wang ZM, Zhu XH, Luo J, Cheng F, Gong L, Zhang J, Wang LH, Zhu WP, Qu XL, Lin Z, Ge WP, Wang BN, Zhu L. Pelvic floor muscle strength and influencing factors based on vaginal manometry among healthy women at different life stages: A multicentre cross-sectional study. BJOG 2024. [PMID: 38168494 DOI: 10.1111/1471-0528.17736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/03/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To assess pelvic floor muscle (PFM) strength and influencing factors among healthy women at different life stages. DESIGN Multicentre cross-sectional study. SETTING Fourteen hospitals in China. POPULATION A total of 5040 healthy women allocated to the following groups (with 1680 women per group): premenopausal nulliparous, premenopausal parous and postmenopausal. METHODS The PFM strength was evaluated by vaginal manometry. Multivariate logistic regression was used to determine the influencing factors for low PFM strength. MAIN OUTCOME MEASURES Maximum voluntary contraction pressure (MVCP). RESULTS The median MVCP values were 36, 35 and 35 cmH2 O in premenopausal nulliparous (aged 19-51 years), premenopausal parous (aged 22-61 years), and postmenopausal (aged 40-86 years) women, respectively. In the premenopausal nulliparous group, physical work (odds ratio, OR 2.05) was the risk factor for low PFM strength, which may be related to the chronic increased abdominal pressure caused by physical work. In the premenopausal parous group, the number of vaginal deliveries (OR 1.28) and diabetes (OR 2.70) were risk factors for low PFM strength, whereas sexual intercourse (<2 times per week vs. none, OR 0.55; ≥2 times per week vs. none, OR 0.56) and PFM exercise (OR 0.50) may have protective effects. In the postmenopausal group, the number of vaginal deliveries (OR 1.32) and family history of pelvic organ prolapse (POP) (OR 1.83) were risk factors for low PFM strength. CONCLUSIONS Physical work, vaginal delivery, diabetes and a family history of POP are all risk factors for low PFM strength, whereas PFM exercises and sexual life can have a protective effect. The importance of these factors varies at different stages of a woman's life.
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Affiliation(s)
- Zhi-Jing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Zhao Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhong-Min Wang
- Department of Obstetrics and Gynecology, Dalian Municipal Women and Children's Medical Center (Group), Dalian, Liaoning, China
| | - Xi-Hui Zhu
- Department of Obstetrics and Gynecology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Jun Luo
- Department of Obstetrics and Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China
| | - Fang Cheng
- Department of Obstetrics and Gynecology, Huaian Maternal and Child Health Hospital, Huaian, Jiangsu, China
| | - Lin Gong
- Department of Obstetrics and Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Jie Zhang
- Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Qinhuangdao, Qinhuangdao, Liaoning, China
| | - Li-Hui Wang
- Department of Obstetrics and Gynecology, Women and Children's Health Care Hospital of Luohu, Shenzhen, Guangdong, China
| | - Wei-Pei Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xue-Ling Qu
- Department of Obstetrics and Gynecology, Changjianglu Pelvic Floor Repair Center, Dalian Maternity and Child Healthcare Center (Group), Dalian, Liaoning, China
| | - Zhong Lin
- Department of Obstetrics and Gynecology, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Wei-Ping Ge
- Department of Obstetrics and Gynecology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Bi-Nan Wang
- Department of Obstetrics and Gynecology, Changsha Hospital for Maternal and Child Health Care Affiliated to Hunan Normal University, Changsha, Hunan, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Fang J, Zhang R, Lin S, Lai B, Chen Y, Lu Y, Wang M, Lin Y, Weng Y, Lin J, Shen J. Impact of parity on pelvic floor morphology and function: A retrospective study. Medicine (Baltimore) 2023; 102:e35738. [PMID: 37960825 PMCID: PMC10637539 DOI: 10.1097/md.0000000000035738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023] Open
Abstract
To analyze the effect of parity on pelvic floor morphology and function during the postpartum period. A total of 971 participants, who attended the Fujian Maternity and Child Health Hospital (Fuzhou, China) between December 2019 and August 2021, were included. All participants were assessed using the modified Oxford scale (MOS), pelvic floor surface electromyography, and 3-dimensional pelvic floor ultrasound to assess pelvic floor morphology and function. Multivariate analysis revealed no differences among primipara, deuteripara, and tertipara in pre-baseline rest, phasic contraction, endurance contraction, post-baseline rest, and MOS, except for tonic contraction (P = .020), the amplitude of which was lower in primipara than in deuteripara in post hoc comparison (P = .008). Differences in bladder neck presentation and bladder neck descent were statistically significant in multivariate analysis (P = .002, P = .001, respectively), with the value of bladder neck presentation in primiparas being greater than that of deuteriparas and tertipara (P = .002, P = .008, respectively), and the value of bladder neck descent was lower than that of deuteripara and tertipara in further post hoc comparisons (P = .002, P = .003, respectively). Functional impairment was not statistically associated with parity according to the MOS score or surface electromyography. However, parity was significantly correlated with descent of the bladder neck, and most of the effects appeared to occur during the first delivery.
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Affiliation(s)
- Jianqi Fang
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
- Fujian Key Laboratory of Women and Children Critical Diseases Research [Fujian Maternity and Child Health Hospital (Fujian Women and Children Hospital)], Fujian, People’s Republic of China
| | - Ronghua Zhang
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Shuqin Lin
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Binglan Lai
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yi Chen
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yao Lu
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Miao Wang
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yang Lin
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Yilin Weng
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Juan Lin
- Master of Medicine, Department of Women Health Care, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Jinming Shen
- Master of Medicine, Department of Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People’s Republic of China
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Gao L, Wang S, Zhang D, Zhu H, Jia Y, Wang H, Li S, Fu X, Sun X, Wang J. Pelvic Floor Muscle Strength in the First Trimester of Primipara: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19. [PMID: 35329251 DOI: 10.3390/ijerph19063568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 01/20/2023]
Abstract
Background: Pelvic floor muscle (PFM) weakness is associated with stress urinary incontinence. Pregnancy is an important risk factor for PFM weakness. Studies evaluating PFM strength in the first trimester of pregnancy are still lacking. Our study aimed to describe pelvic floor function of the primipara in the first trimester of gestation and investigate the risk factors for PFM weakness. Methods: Primiparas aged 20~40 years with a singleton pregnancy less than 14 weeks of gestation were recruited, and data were collected via questionnaires on items that were suggested as associated with PFM weakness, followed by Modified Oxford Scale (MOS) on genital hiatus and perineal body and pelvic floor ultrasound evaluation for the thickness of the left and right levator ani muscles (LAM), right−left diameter of the levator hiatus (LH), and LH area. Participants were divided into three groups by MOS >3, =3, and <3 for data analysis. Results: A total of 380 participants completed the questionnaires and examinational analysis, of whom, 228, 98, and 54 were divided into Group 1, Group 2, and Group 3, respectively. The three groups were significantly different in the number of gestations and abortions, toilet types, and the right−left diameter of the LH (p < 0.05). Logistic regressive analysis showed that squatting toilet dominant (OR = 3.025; 95% CI: 1.623~5.638; p < 0.001) and a larger right−left diameter of the LH (OR = 1.065; 95% CI: 1.026~1.105; p = 0.001) were significantly associated with PFM weakness. Conclusions: Squatting toilet dominancy and longer right−left diameter of the LH are significantly associated with PFM weakness in primiparas in the first trimester. Sitting toilets should be recommended to women, especially pregnant women. Trial registration: The trial has been registered at Chinese Clinical Trial Registry (registration number: ChiCTR2000029618).
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Shaw JM, Zhou J, Hitchcock R, Nygaard IE, Niederauer S, Sheng X. Relative and Maximal Intra-abdominal Pressure and Postpartum Pelvic Floor Outcomes in Primiparas Delivered Vaginally. Female Pelvic Med Reconstr Surg 2022; 28:96-103. [PMID: 34387260 DOI: 10.1097/SPV.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to explore associations between relative and maximal intra-abdominal pressure (IAP) on pelvic floor outcomes in primiparas delivered vaginally. METHODS At 5-10 weeks and 1 year postpartum, we measured absolute IAP by vaginal sensor while participants lifted a weighted car seat (IAPLIFT) and performed isometric trunk flexion endurance (IAPTFE) and seated maximal strain (IAPSTRAIN). Primary outcomes, completed 1 year postpartum, included worse pelvic floor support (descent to or beyond the hymen) and positive symptom burden (bothersome symptoms in ≥2 of 6 domains on the Epidemiology of Prolapse and Incontinence Questionnaire). We calculated relative IAP (as absolute IAP/IAPSTRAIN). RESULTS Of 542 participants, 9.7% demonstrated worse support and 54.3% demonstrated symptom burden at 1 year postpartum. In multivariable analyses, absolute IAPLIFT and absolute IAPTFE at 5-10 weeks postpartum were not associated with worse support. As relative IAP at 5-10 weeks increased, the prevalence of worse support decreased (prevalence ratio [PR] of 0.77 [95% confidence intervals (CIs), 0.63-0.94] and PR of 0.79 [95% CI, 0.67-0.93]) per 10% increase for relative IAPLIFT and relative IAPTFE, respectively. This was largely due to IAPSTRAIN, which increased the prevalence of worse support (PR, 1.15 [95% CI, 1.06-1.25]) per 10 cm H2O increase. One year postpartum, only IAPSTRAIN increased the prevalence of worse support (PR, 1.11 [95% CI, 1.02-1.20]) per 10 cm H2O. Of all IAP measures at both time points, only absolute IAPLIFT at 1 year significantly increased the prevalence of symptom burden (PR, 1.11 [95% CI, 1.05-1.18]) per 10 cm H2O. CONCLUSIONS This exploratory analysis suggests that postpartum IAPSTRAIN may increase the prevalence of worse support in primiparas delivered vaginally.
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Bag Soytas R, Soytas M, Danacioglu YO, Citgez S, Yavuzer H, Can G, Onal B, Doventas A. Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women. Neurourol Urodyn 2021; 40:1532-1538. [PMID: 34004030 DOI: 10.1002/nau.24699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022]
Abstract
AIM To investigate the relationship between handgrip strength with types of urinary incontinence (UI) and pelvic floor muscle strength (PFMS) in women. METHODS Ninety-two women, who presented to the geriatric and urology outpatient clinics complaining of UI between July 2019 and February 2020 and had indicated to undergo urodynamic assessment after basic neurourological evaluation, were included in this cross-sectional study. The presence and types of UI were identified by clinical examination and urodynamic studies. Demographic parameters, anthropometric data, comorbidities and medications were recorded. The International Consultation on Incontinence Questionnaire-Short Form was applied. Handgrip strength (HGS) was measured by a hand dynamometer. The PFMS was subjectively assessed via vaginal digital palpation and measured quantitatively by the vaginal probe of the perineometer. RESULTS Thirty-eight urodynamic stress, 28 detrusor overactivity, 26 urodynamic mixed UI patients were reported. Perineometer measurements were significantly lower in the urodynamic stress UI group compared to the other two groups (p = 0.020). There was no relationship between the types of urinary incontinence and HGS. However, a positive correlation was found between PFMS and HGS (p = 0.045, r = 0.298). CONCLUSION The positive correlation between HGS and PFMS indicates that low HGS may be a marker for PFMS weakness. Furthermore, the association between sarcopenia and UI may be explained by this condition.
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Affiliation(s)
- Rabia Bag Soytas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mustafa Soytas
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Yavuz O Danacioglu
- Department of Urology, Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Sinharib Citgez
- Department Of Urology, Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Bulent Onal
- Department Of Urology, Istanbul University-Cerrahpasa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Fuentes-Aparicio L, Arranz-Martín B, Navarro-Brazález B, Bailón-Cerezo J, Sánchez-Sánchez B, Torres-Lacomba M. 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. Int J Environ Res Public Health 2021; 18:3708. [PMID: 33918217 DOI: 10.3390/ijerph18073708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Gümüşsoy S, Öztürk R, Kavlak O, Hortu İ, Yeniel AÖ. Investigating Pelvic Floor Muscle Strength in Women of Reproductive Age and Factors Affecting It. Clin Nurs Res 2021; 30:1047-1058. [PMID: 33719590 DOI: 10.1177/10547738211000350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This descriptive study was designed to investigate the pelvic floor muscle strength (PFMS) of women aged 18 to 49 years and to examine the factors that may have an effect on PFMS. The study was conducted on 258 women who visited a gynecology outpatient clinic between January 2019 and January 2020, who met the research criteria, and who agreed to participate in the study. The data were collected using the Sociodemographic Characteristics Information Form. The Modified Oxford Scale (MOS) and a perineometer were used to evaluate the PFMS of the women. The mean PFMS value measured using the perineometer was 31.56 ± 12.17 cmH2O (moderate pressure). The PFMS values were 20.00 to 29.9 cmH2O (weak pressure) and 30.00 to 39.9 cmH2O (moderate pressure) in 23.6% of the women, respectively. The PFMS values measured with MOS were of grade 3 strength (moderate pressure) in 23.6% of the women and grade 2 strength (weak pressure) in 23.3%. A statistically significant strong correlation was found between the perineometer measurement and the women's MOS values. Moreover, a statistically significant difference was found between the PFMS values measured with the perineometer, MOS scores, and women's age groups, educational status, marital status, employment status, income status, persistent cough, use of nicotine, alcohol and coffee consumptions, chronic constipation, history of frequent urinary tract infections, regular exercise, body mass index, history of pregnancy, mode of delivery, use of episiotomy at birth, perineal rupture at birth, use of forceps vacuum at birth, multiple pregnancies, delivery of a baby weighing ≥4,000 g, treatment during pregnancy, hysterectomy, menopause, frequency of sexual intercourse, and pain during sexual intercourse (p < .05). We conclude that most of the women in the study had weak to moderate PFMS, that the evaluation of PFMS with the MOS positively overlapped with the perineometric measurements, and that a number of sociodemographic and obstetric variables act as risk factors that affect PFMS. The PFMS of all women should be assessed as part of their routine gynecological examinations.
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Affiliation(s)
- Süreyya Gümüşsoy
- Ege University Atatürk Health Care Vocational School, Izmir, Turkey
| | - Ruşen Öztürk
- Ege University Faculty of Nursing, Izmir, Turkey
| | - Oya Kavlak
- Ege University Faculty of Nursing, Izmir, Turkey
| | - İsmet Hortu
- Ege University Faculty of Medicine, Izmir, Turkey
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Myer EN, Roem JL, Lovejoy DA, Abernethy MG, Blomquist JL, Handa VL. Longitudinal changes in pelvic floor muscle strength among parous women. Am J Obstet Gynecol 2018; 219:482.e1-482.e7. [PMID: 29902445 DOI: 10.1016/j.ajog.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is limited knowledge of the effects of time on change in pelvic floor muscle strength after childbirth. OBJECTIVE The objectives of this study were to estimate the change in pelvic floor muscle strength in parous women over time and to identify maternal and obstetric characteristics associated with the rate of change. STUDY DESIGN This is an institutional review board-approved prospective cohort study of parous women. Participants were recruited 5-10 years after first delivery and followed annually. Pelvic floor muscle strength (peak pressure with voluntary contraction) was measured at 2 annual visits approximately 4 years apart with the use of a perineometer. We calculated the change in peak pressures, which were standardized per 5-year interval. Linear regression was used to identify maternal and obstetric characteristics that are associated with the rate of change in peak pressure. The obstetric variable of greatest interest was delivery group. Participants were classified into 3 delivery groups (considering all deliveries for each multiparous woman). Delivery categories included cesarean only, at least 1 vaginal birth but no forceps-assisted deliveries, and at least 1 forceps-assisted vaginal birth. Statistical analysis was completed with statistical software. RESULTS Five hundred forty-three participants completed 2 perineometer measurements with a median 4 years between measures (interquartile range, 3.1-4.8). At initial measurement, women were, on average, 40 years old and 8 years from first delivery. Initial strength was higher in participants who delivered all their children by cesarean (38.5 cm H2O) as compared with women with any vaginal non-forceps delivery (26.0 cm H2O) or vaginal forceps delivery (13.5 cm H2O; P<.001). There was a strong correlation between the first and second perineometry measurement (r=0.84). Median change in pelvic floor muscle strength was small at 1.2 cm H2O per 5 years (interquartile range, -5.6, 9.9 cm H2O). In multivariable analysis, women who delivered by cesarean only demonstrated almost no change in strength over 5 years (0.2 increase cm H2O per 5 years); those who experienced at least 1 vaginal or vacuum delivery increased strength (4.8 cm H2O per 5 years) as did women with at least 1 forceps delivery (5.0 cm H2O per 5 years). Additionally, obese women had a significant reduction in strength (-3.1 cm H2O per 5 years) compared with normal weight participants (0.2 cm H2O per 5 years). CONCLUSION Among parous women, pelvic muscle strength increased minimally over time with an average change of 1.2 cm H2O per 5 years; change in strength was associated with mode of delivery and obesity.
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Gomes CS, Pedriali FR, Urbano MR, Moreira EH, Averbeck MA, Almeida SHM. The effects of Pilates method on pelvic floor muscle strength in patients with post-prostatectomy urinary incontinence: A randomized clinical trial. Neurourol Urodyn 2017; 37:346-353. [PMID: 28464434 DOI: 10.1002/nau.23300] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/17/2017] [Indexed: 11/08/2022]
Abstract
AIMS To assess the effects of a Pilates exercise program compared to conventional pelvic floor muscle training (PFMT) protocol on pelvic floor muscle strength (PFMS) in patients with post-prostatectomy urinary incontinence. METHODS Patients were randomized into three treatment groups (G1: Pilates, G2: electrical stimulation combined with PFMT, and G3: control group). Duration of therapy was 10 weeks. Baseline assessment included the 24 h pad-test and the ICI-Q questionnaire. PFMS was measured using a manometric perineometry device at baseline and 4 months after radical prostatectomy (RP). The level of significance was P < 0.05. RESULTS One hundred twenty three patients were randomized and 104 patients completed the study protocol (G1: n = 34; G2: n = 35; G3: n = 35). Post-treatment assessment showed statistically significant improvements in maximum strength in G2, increased endurance in G1 and G2, and increment of muscle power in all three groups (P < 0.05). However, there were no significant differences in the mean changes of maximum strength, endurance, and muscle power between groups after treatment (P > 0.05). G1 and G2 achieved a higher number of fully continent patients than G3 (P < 0.05). At the end of treatment, 59% of patients in G1, 54% in G2, and 26% in G3 were continent (no pads/day). CONCLUSIONS Improvements in PFMS parameters were distinct among active treatment groups versus controls, but did not predict recovery of urinary continence at final assessment. The Pilates method promoted similar outcomes in the proportion of fully continent patients when compared to conventional PFMT 4 months after RP.
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Affiliation(s)
- Cíntia S Gomes
- Physiotherapist, State University of Londrina, Londrina, Brazil
| | | | - Mariana R Urbano
- Statistics Department, State University of Londrina, Londrina, Brazil
| | - Eliane H Moreira
- Physiotherapy Department, Center for Health Sciences, State University of Londrina, Londrina, Brazil
| | - Marcio A Averbeck
- Department of Urology, Video Urodynamics Unit, Moinhos de Vento Hospital, Porto Alegre, Brazil
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Navarro Brazález B, Torres Lacomba M, de la Villa P, Sánchez Sánchez B, Prieto Gómez V, Asúnsolo Del Barco Á, McLean L. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study. Neurourol Urodyn 2017; 37:269-277. [PMID: 28455942 DOI: 10.1002/nau.23287] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/12/2017] [Indexed: 11/10/2022]
Abstract
AIMS The purposes of this study were: (i) to evaluate the reliability of vaginal palpation, vaginal manometry, vaginal dynamometry; and surface (transperineal) electromyography (sEMG), when evaluating pelvic floor muscle (PFM) strength and/or activation; and (ii) to determine the associations among PFM strength measured using these assessments. METHODS One hundred and fifty women with pelvic floor disorders participated on one occasion, and 20 women returned for the same investigations by two different raters on 3 different days. At each session, PFM strength was assessed using palpation (both the modified Oxford Grading Scale and the Levator ani testing), manometry, and dynamometry; and PFM activation was assessed using sEMG. RESULTS The interrater reliability of manometry, dynamometry, and sEMG (both root-mean-square [RMS] and integral average) was high (Lin's Concordance Correlation Coefficient [CCC] = 0.95, 0.93, 0.91, 0.86, respectively), whereas the interrater reliability of both palpation grading scales was low (Cohen's Kappa [k] = 0.27-0.38). The intrarater reliability of manometry (CCC = 0.96), and dynamometry (CCC = 0.96) were high, whereas intrarater reliability of both palpation scales (k = 0.78 for both), and of sEMG (CCC = 0.79 vs 0.80 for RMS vs integral average) was moderate. The Bland-Altman plot showed good inter and intrarater agreement, with little random variability for all instruments. The correlations among palpation, manometry, and dynamometry were moderate (coefficient of determination [r2 ] ranged from 0.52 to 0.75), however, transperineal sEMG amplitude was only weakly correlated with all measures of strength (r2 = 0.23-0.30). CONCLUSIONS Manometry and dynamometry are more reliable tools than vaginal palpation for the assessment of PFM strength in women with pelvic floor disorders, especially when different raters are involved. The different PFM strength measures used clinically are moderately correlated; whereas, PFM activation recorded using transperineal sEMG is only weakly correlated with PFM strength. Results from perineal sEMG should not be interpreted in the context of reporting PFM strength.
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Affiliation(s)
- Beatriz Navarro Brazález
- Physical Therapy in Women's Health Research Group, Faculty of Medicine and Health Sciences, Physical Therapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Torres Lacomba
- Physical Therapy in Women's Health Research Group, Faculty of Medicine and Health Sciences, Physical Therapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Pedro de la Villa
- Physical Therapy in Women's Health Research Group, Faculty of Medicine and Health Sciences, Physical Therapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Beatriz Sánchez Sánchez
- Physical Therapy in Women's Health Research Group, Faculty of Medicine and Health Sciences, Physical Therapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Virginia Prieto Gómez
- Physical Therapy in Women's Health Research Group, Faculty of Medicine and Health Sciences, Physical Therapy Department, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Ángel Asúnsolo Del Barco
- Preventive Medicine and Health Science Unit, Faculty of Medicine and Health Sciences, Department of Surgery, Medical and Social Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Linda McLean
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Middlekauff ML, Egger MJ, Nygaard IE, Shaw JM. The impact of acute and chronic strenuous exercise on pelvic floor muscle strength and support in nulliparous healthy women. Am J Obstet Gynecol 2016; 215:316.e1-7. [PMID: 26899909 DOI: 10.1016/j.ajog.2016.02.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Strenuous physical activity, which is known to increase intraabdominal pressure and theoretically places stress on the pelvic floor, may affect pelvic support in nulliparous women. OBJECTIVE The aims of this study were to: (1) examine the differences in maximal vaginal descent (MVD), vaginal resting pressure (VRP), and pelvic floor muscle strength (PFMS) between women who habitually perform strenuous exercise vs women who refrain from performing strenuous exercise; and (2) compare MVD, VRP, and PFMS before and immediately following physical activity in the strenuous and nonstrenuous groups separately. STUDY DESIGN Participants were healthy nulliparous women ages 18-35 years who were habitual strenuous or nonstrenuous exercisers. Women in the strenuous group participated in CrossFit (CrossFit, Inc., Washington, DC) at least 3 days per week for at least 6 months. We assessed anthropometric and body composition values using standardized procedures. Participants completed the Pelvic Organ Prolapse Quantification examination and pelvic muscle strength assessment before and again within 15 minutes of completing exercise (CrossFit for the strenuous group and self-paced walking for the nonstrenuous). A research nurse masked to study group assignment recorded MVD, defined as the greatest value of anterior, posterior, or apical support, and VRP and PFMS using a perineometer. Maximal PFMS was recorded as the highest pressure measured in 3 vaginal contraction trials. Data were analyzed using parametric and nonparametric tests as appropriate. P < .05 was considered significant. RESULTS Seventy nulliparous women participated in the study, 35 in each group. The mean age was 24.77 ± 4.3 years. Compared to the nonstrenuous group, strenuous participants were heavier (64.70 ± 7.78 kg vs 60.6 ± 8.99 kg, P = .027), had lower percent body fat (23.36 ± 5.88% vs 27.55 ± 7.07%, P = .003), and had higher handgrip strength (20.78 ± 5.97 kg vs 16.04 ± 11.04 kg, P = .001). Before exercise, there were no significant differences in VRP (P = .167), MVD (P = .49), or maximal PFMS (P = .773) between the strenuous and nonstrenuous groups. Immediately following exercise, we observed significant increases in MVD in both the strenuous (P = .008) and nonstrenuous (P = .025) groups, indicating marginal decreases in support. VRP significantly decreased in both groups after exercise. Maximal PFMS did not change significantly in either group after exercise. CONCLUSION After an exercise bout typical for each group, vaginal support and VRP decreased slightly in both groups. Based on preexercise measures, chronic strenuous exercise demonstrated neither beneficial nor deleterious effects on pelvic floor strength or support. While strenuous women had greater grip strength than nonstrenuous women, PFMS was not significantly greater, suggesting that targeted pelvic floor muscle strengthening, rather than general muscle fitness, is needed to maximize PFMS.
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Celiker Tosun O, Kaya Mutlu E, Ergenoglu AM, Yeniel AO, Tosun G, Malkoc M, Askar N, Itil IM. Does pelvic floor muscle training abolish symptoms of urinary incontinence? A randomized controlled trial. Clin Rehabil 2014; 29:525-37. [PMID: 25142280 DOI: 10.1177/0269215514546768] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 07/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether symptoms of urinary incontinence is reduced by pelvic floor muscle training, to determine whether urinary incontinence can be totally eliminated by strengthening the pelvic floor muscle to grade 5 on the Oxford scale. DESIGN Prospective randomized controlled clinical trial. SETTING Outpatient urogynecology department. SUBJECTS One hundred thirty cases with stress and mixed urinary incontinence. INTERVENTION All participants were randomly allocated to the pelvic floor muscle training group or control group. A 12-week home based exercise program, prescribed individually, was performed by the pelvic floor muscle training group. MAIN MEASURES Urinary incontinence symptoms (Incontinence Impact Questionnaire-7, Urogenital Distress Inventory-6, bladder diary, stop test and pad test) were assessed, and the pelvic floor muscle strength was measured for (PERFECT testing, perineometric and ultrasound) all participants before and after 12 weeks of treatment. RESULTS The pelvic floor muscle training group had significant improvement in their symptoms of urinary incontinence (P=0.001) and an increase in pelvic floor muscle strength (P=0.001, by the dependent t test) compared with the control group. All the symptoms of urinary incontinence were significantly decreased in the patients that had reached pelvic floor muscle strength of grade 5 and continued the pelvic floor muscle training (P<0.05). CONCLUSION The study demonstrated that pelvic floor muscle training is effective in reducing the symptoms of stress and mixed urinary incontinence and in increasing pelvic floor muscle strength.
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Affiliation(s)
- O Celiker Tosun
- Dokuz Eylül University, School of Physiotherapy and Rehabilitation, Turkey
| | - E Kaya Mutlu
- Istanbul University, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Turkey
| | - A M Ergenoglu
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - A O Yeniel
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - G Tosun
- Tepecık Educaution and Research Hospital, Department of Obstetric and Gynecology, Turkey
| | - M Malkoc
- Dokuz Eylül University, School of Physiotherapy and Rehabilitation, Turkey
| | - N Askar
- Ege University, Department of Obstetric and Gynecology, Turkey
| | - I M Itil
- Ege University, Department of Obstetric and Gynecology, Turkey
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