C0089 The abdominal and pelvic floor muscular response during a hypopressive exercise: dynamic transabdominal ultrasound assessment

Abstract

Background Hypopressive exercises are suggested for the prevention and conservative treatment of pelvic floor dysfunction. The aim of hypopressive exercises is to strengthen abdominal and pelvic floor muscles (PFM) through the descent of the intra-abdominal pressure. Transabdominal ultrasound imaging is a helpful procedure for assessing the abdominal muscle and PFM activity during the performance of a hypopressive exercise. Methods A sample of nineteen non-pregnant women was recruited. All the participants had previously finished a two-month individual physiotherapy treatment based on hypopressive exercises. The women were instructed to perform a hypopressive repetition that involved a maintained apnea after a forced expiration. The apnea was held for 10 s during which participants tried to expand their ribs and to rise the abdominal wall. Transabdominal ultrasound assessment was performed in supine position, with a 12 MHz straight linear array ultrasound transducer (Model L14 6Ns, Mindray, Shenzen). In order to measure the increase of the cross-sectional area of abdominal muscles, the probe was placed transversely on the right side of the abdominal wall. The PFM action was recorded above the pubis bone in midtransversal and midsagittal planes. Results The whole sample achieved a PFM rise during the hypopressive exercise. The transverse abdominis muscle increased it cross-sectional area, whereas the other abdominal muscles showed different behaviour among the participants. The mean (standard deviation) age of the women was 44.64 (±8.23) with a body mass index of 23.13 (±3.09) kg/cm2. A 78.9% of women presented at least one pelvic floor dysfunction. The PFM lifted a median (interquartile range) of 6.6 (±4.8) cm in transversal plane and 4.4 (±4.6) cm in sagittal plane. The cross-sectional area increase of abdominal muscles was 1.7 (±1) cm in transverse abdominis muscle, 1.1 (±2.2) cm in internal oblique muscle, 0.4 (±1.6) cm in external oblique muscle and 0.2 (±1.8) cm in rectus abdominis muscle. However, in seven women, the external oblique and rectus abdominis muscles showed a decreased area, and the same phenomenon occurred to five participants in the internal oblique muscle. Conclusions Hypopressive exercises produced the elevation of PFM without a direct contraction command. Transversus abdominis muscle also contracted indirectly during a hypopressive exercise, whereas the other abdominal muscles response was not regular.