Floor Muscle Function In Women Research Articles

Quantitative tools to assess pelvic floor muscle function - systematic review.

Urinary incontinence is pelvic floor muscles dysfunction, most often caused by a weakening of their strength. There are no guidelines on how to evaluate pelvic floor muscle function. Palpation is the most popular method of assessing pelvic floor muscle function, but it is subjective. The aim of the study was to review the objective methods used in the assessment of pelvic floor muscle function in women with urinary incontinence. A systematic literature review of the PubMed database was performed using the following keywords: ["Pelvic Floor" (mh)] AND [("Pelvic Floor Disorders" (mh)] OR ["Urinary Incontinence" (mh)]. The search was limited to English-language works published from 2011 to 2021. The inclusion criteria were interventional studies in which the pelvic floor muscle function of women with urinary incontinence was assessed using quantitative tools. Methods that cannot be used in the clinic were excluded from the analysis. Fifty-two articles were included in the analysis and five methods assessing the function of pelvic floor muscle were distinguished: manometry, electromyography (EMG), ultrasonography (USG), dynamometry, accelerometry. Manometry, EMG and USG are the most common objective methods of assessing pelvic floor muscle function. When taking measurements, it is important to choose the right position of the patient. The use of objective tools to assess the function of the pelvic floor muscle and obtaining quantitative and/or qualitative data allows us to precisely diagnose and monitor the treatment and rehabilitation progress.

Pelvic floor muscle function in women with and without breast cancer: A cross-sectional study

Introduction:The aim of this study was to quantify PF muscle function in women with and without breast cancer using pressure manometry, digital palpation and transperineal ultrasound. Methods:This cross-sectional study included women with and without breast cancer. The primary outcome was PF muscle strength measured as maximal squeeze pressure (cmH2O). Differences between groups were analysed using independent t-tests or chi-square tests. Results:The group with breast cancer was older (mean age: 54 years) than the group without breast cancer (mean age: 38 years, p<0.0001). Participants with breast cancer had significantly weaker PF muscles as measured by maximal squeeze pressure (breast cancer group: mean 18 cmH2O, 95% CI 15, 21; control group: mean 29 cmH2O, 95% CI 27, 32; p<0.0001) and digital examination (strength rated as weak: 30% in participants with breast cancer compared to 9% in control group, p=0.0167). Relaxation ability was poorer in participants with breast cancer than control group participants (p=0.0039). Conclusion:Our cohort of women with breast cancer demonstrated reduced PF muscle strength and poorer relaxation ability compared to those without breast cancer. This finding suggests that therapies such as PF muscle training or relaxation techniques may be therapeutic targets to improve PF muscle function.

Comparison of Pelvic Floor Muscle Function in Women With Stress Urinary Incontinence and Overactive Bladder and Healthy Women

Background and Aims Urinary incontinence (UI) has been known as one of the clinical manifestations of pelvic floor muscle (PFM) instability; however, limited research has been published on PFM function in patients with different types of UI. This study aimed to compare the PFM function of the continent women and women with Stress urinary incontinence (SUI) and overactive bladder (OAB). Methods This cross-sectional comparative study was performed on 30 women, 10 continents, 10 SUI, and 10 OAB, with a mean age of 42.67±4.77 years. PFM function was assessed using manual muscle testing, a perimeter, and surface electromyography. Data analysis was performed using SPSS software and the level of significance was considered as P≥0. 05. Results There was no significant difference in the PFM function, strength, and electromyographic activity between SUI and OAB patients. However, it decreased in both groups compared to the healthy group (P=0.001). Also, a strong correlation was found between clinical examination, a perimeter, and electromyography (r=0.82, P=0.0001). Conclusion This study revealed that the PFM function was impaired in both groups of women with SUI and OAB. Also, both manual examination and the perimeter can be used as clinical methods in evaluating PFM function.

Pelvic floor muscle function in women with and without urinary incontinence: are strength and endurance the only relevant functions? a cross-sectional study

ObjectivesTo investigate if pelvic floor muscle functions (PFMFs), besides strength and endurance, are associated with the occurrence of urinary incontinence (UI) in women, and to investigate which functions predict the occurrence of UI. DesignCross-sectional study. SettingPublic health service and community. ParticipantsTwo hundred and ten women (101 with UI and 109 without UI). Main outcome measuresPFMF was investigated by the Pelvic Floor Sensory and Muscle Function Exam (Exame das Funções Sensoriais e Musculares do Assoalho Pélvico), a valid and reliable instrument that measures the following functions: tone, reaction, control (contraction), control (relaxation), coordination, strength and endurance. The International Consultation on Incontinence Questionnaire-Short Form was used to document the occurrence and type of UI. Sociodemographic and clinical data were collected through the questionnaire. Chi-squared test, Student’s t-test and Mann–Whitney test were used to evaluate the association of each function with UI. Two logistic regression models tested the predictive value of each function for UI: Model a included all of the above PFMFs and Model b included all of the above PFMFs except strength and endurance. ResultsMost sociodemographic and clinical risk factors differed between women with UI and women without UI. On univariate analysis, tone, reaction, control (contraction), coordination, strength and endurance were found to be significantly associated (P<0.05) with the occurrence of UI. On multivariate analysis, Model a explained 69% and Model b explained 61% of the likelihood of UI, respectively. ConclusionsBesides strength and endurance, pelvic floor muscle tone, reaction, control (contraction) and coordination were significantly associated with the occurrence of UI, and should be investigated further.

The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

To systematically review the evidence for the effect of pelvic organ prolapse (POP) and/or continence surgery on pelvic floor muscle (PFM) morphometry and function in women, and to investigate whether a relationship exists between PFM measures and clinician-reported objective pelvic floor outcomes postoperatively. Six electronic databases were searched until March 2018. Studies were included if they examined the effect of POP and/or continence surgery on the PFM in women, and reported pre- and postoperative data. Methodological quality was assessed using a modified Downs and Black checklist. Three meta-analyses were planned based on postoperative follow-up time. Twenty-one studies met the inclusion criteria. Varied surgical interventions and 33 different PFM measures were represented. The methodological quality of included studies varied considerably. The 0 to 6 weeks postoperative meta-analysis showed no statistically significant change in PFM function (SMD = 0.04; 95% confidence interval [CI] = -0.26 to 0.33). This was consistent at 3 and 6 or more months (SMD = 1.13; 0.35 95% CI = -0.34 to 2.60, - 0.42 to 1.12 respectively). None of the included studies investigated the relationship between PFM measures and clinician-reported objective outcomes postoperatively. This review did not show a clear effect of POP and/or continence surgery on PFM morphometry or function in women and was unable to show a relationship with outcomes such as objective prolapse score and urodynamic findings. This could be because surgery does not measurably impact on the PFM or due to the poor quality and heterogeneity of studies. Future well-designed research is needed to specifically investigate change in the PFM following surgery.

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

Pelvic floor muscle function (PFMF) is a target of the physical therapist intervention for women with urinary incontinence (UI). However, possible variations in PFMF terminology might hamper communication among researchers and health care professionals in Women's Health. The objective of this study was to investigate the terminology of PFMF regarding clear terms, conceptual definitions, and operational definitions. Data sources include PUBMED, CINAHL, LILACS, and SCIELO. Observational studies investigating any PFMF in women with or without UI, published in English, Spanish, or Portuguese from 2005 through 2017, were considered. The risk of bias was assessed by a questionnaire on the quality of observational studies. Data on terminology were extracted as terms, conceptual definitions, and operational definitions of PFMF and were synthesized according to key words, key ideas, and key operationalization, respectively. Consistencies and variations were identified for the most frequently investigated PFMF. Sixty-four studies were included, and a low risk of bias was identified. All studies presented terms and operational definitions of PFMF, but only 29.7% presented conceptual definitions of those terms. One hundred ninety-six different terms referred to PFMF. According to similarities in terminology, 161 PFMF terms could be grouped under 26 terms; the other 35 were left ungrouped. Therefore, a total of 61 different PFMF terms were identified in the literature. A limitation in the study was that only observational studies were included. A large variation in PFMF terminology was identified, precluding data gathering and meta-analysis. The lack of use of standardized terminology delays the progress of scientific knowledge and evidence-based practice dissemination. Efforts toward creating a collaborative, consensual terminology based on a sound framework are necessary.

A manometry classification to assess pelvic floor muscle function in women.

ObjectiveTo develop a classification scale for manometry of pelvic floor muscles (PFM) in Brazilian women, according to the modified Oxford scale.MethodsA cross sectional study, with 288 women enrolled in the Maternity, Natal, Brazil. Manometry and PFM strength data were collected and classified according to the modified Oxford scale. A simple linear regression was performed to determine the classification scale of manometry using the modified Oxford scale as the explanatory variable and the arithmetic mean of the manometry measurements as the response variable.ResultsThe average age was 52.80 (±8.78; CI: 51.67–53.93) years. Manometry showed an average of 35.1 (±22.7; CI: 32.1–38.0) cmH2O and most women (29.7%) scored grade 3 on the modified Oxford scale. According to the proposed scale, values between 7.5 to 14.5 cmH2O correspond to very weak pressure; 14.6 to 26.5 cmH2O represent weak pressure; 26.6 to 41.5 cmH2O represent moderate pressure; 41.6 to 60.5 cmH2O represent good pressure, and values above 60.6 cmH2O correspond to strong pressure.ConclusionManometry values were rated on a five-point scale. It is possible to rank the pressure levels performed by voluntary contraction of PFM with this new scale.

Relationship between stress urinary incontinence and pelvic floor muscle function in women using an extracorporeal biofeedback device

Relationship between stress urinary incontinence and pelvic floor muscle function in women using an extracorporeal biofeedback device

Pelvic floor muscle function in women with provoked vestibulodynia and asymptomatic controls.

The purpose of the present study was to assess vaginal resting pressure (VRP), pelvic floor muscle (PFM) strength and endurance, and surface EMG activity in women with and without provoked vestibulodynia (PVD). This was an assessor-masked comparison study including 70 women. Exclusion criteria were any previous pregnancy and presence of candida. Sensitivity of the vulvar vestibule was rated at three sites with Q-tip pressure measurement and a numerical rating scale for pain. VRP and PFM strength and endurance were measured with a high precision pressure transducer connected to a vaginal balloon. Pelvic floor muscle activity was measured with surface EMG. The independent samples t test was used to analyze differences between groups. The p value was set to <0.05 RESULTS: The mean age of the participants was 24.3 years (SD 4.7) and mean body mass index (BMI) was 22.0 kg/m(2) (SD 2.6). Q-tip pressure measurement was significantly lower and pain more severe in the PVD group at all sites of the vulvar vestibule. The PVD group had significantly higher VRP: 20.6 cmH2O (SD 7.1) versus controls: 17.3 cmH2O (SD 4.4), p = 0.02. The PVD group had significantly lower muscle activity during a 10-s holding period; PVD: 465.2 μV (SD 218.4), controls: 591.1 μV (SD 277.7), p = 0.04. Young, nulliparous women with PVD had significantly higher VRP, but this finding was not confirmed by vaginal surface EMG.

Pelvic floor muscle function in women with pelvic floor dysfunction

The objectives of this study were to investigate the level of pelvic floor muscle (PFM) function in women with pelvic floor dysfunction (PFD) referred by gynaecologists and urologists for in-hospital pelvic floor muscle training (PFMT), and to identity associated factors for a low level of PFM function. Data of women with PFD referred to a PFMT programme were included in a retrospective chart review. Measurement of PFM function performed by digital vaginal palpation included: voluntary PFM contraction, PFM strength (Modified Oxford Grading Scale) and PFM static endurance. Data of 998 women, mean age 56 (SD 13) years, with PFD (urinary incontinence, n = 757, anal incontinence, n = 36, pelvic organ prolapse, n = 111, other PFD, n = 94) were analysed. In all, 690 women (70%) were, at baseline, unable to perform correct voluntary PFM contraction, mean PFM strength was 1.5 (SD 1.0) points, mean PFM static endurance was 16.7 (SD 16.1) seconds. Age ≥ 65 years and year of referral > 2000 were significantly (p < 0.01) associated with the ability to perform correct PFM contraction. Likewise, year of referral was significantly associated with high PFM strength (p < 0.01). The majority of the women were unable to perform correct voluntary PFM contraction and almost all had low PFM strength. The most important factor associated with a low level of PFM function was age.

Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse?

The aim of the study was to compare the effect of hypopressive exercises including pelvic floor muscle contraction, pelvic floor muscle training (PFMT) alone and control on pelvic floor muscle function in women with pelvic organ prolapse (POP). Fifty-eight women with a mean age of 55.4 (± 9.8) years old with stage II POP were randomly assigned to participate in the PFMT group, the hypopressive exercises associated with PFMT (HE + PFMT) group or the control group. Each treatment group underwent a 3-month course of treatment. The three groups received lifestyle advice regarding weight loss, constipation, coughing, and the avoidance of heavy lifting. Participants were evaluated before and after the treatment. Maximal voluntary contraction (MVC) and endurance were assessed using the Modified Oxford grading system. To evaluate muscle activation, surface electromyography (SEMG) was used. The two treatment group significantly increase pelvic floor muscle function as measured by MVC (P < 0.001) using the Modified Oxford grading system, as well as muscle activation (P < 0.001), measured by SEMG. The PFMT group was superior regarding endurance (P = 0.007). Both groups were superior to the control group regarding MVC, endurance and muscle activation. Adding hypopressive exercises to PFMT does not improve PFM function. Both treatment groups performed better than the control group.

Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound

Pelvic floor muscle (PFM) dysfunction has been recently associated with the development of low back pain (LBP). Transabdominal ultrasound imaging has been established as an appropriate method for visualizing and measuring PFM function. No study has directly evaluated PFM function in individuals with and without LBP. The purpose of this study was to investigate the PFM function in women with and without LBP using transabdominal ultrasound. Convenience sample of 40 non-pregnant female participated in the study. Subjects were categorized into two groups: with LBP (n = 20) and without LBP (n = 20). The amount of bladder base movement on ultrasound (normalized to body mass index) was measured in all subjects and considered as an indicator of PFM function. Statistical analysis (Independent t-test) revealed significant difference in transabdominal ultrasound measurements for PFM function between the two groups (P = 0.04, 95% CI of difference: 0.002–0.27).The results of this study indicate PFM dysfunction in individuals with LBP compared to those without LBP. The results could be beneficial to clinicians when assessing and prescribing therapeutic exercises for patients with LBP.

Pelvic floor muscle function in women presenting with pelvic floor disorders

This observational study was undertaken to determine knowledge, prior instruction, frequency of performance, and ability to perform pelvic floor muscle exercises in a group of women presenting for evaluation of pelvic floor disorders. Three hundred twenty-five women presenting for evaluation of pelvic floor disorders were questioned concerning knowledge and performance of pelvic floor muscle exercises (PMEs) and then examined to determine pelvic floor muscle contraction strength. The majority of women (73%) had heard of PMEs, but only 42% had been instructed to perform them and 62.5% stated they received verbal instruction only. Only 23.4% of patients could perform pelvic muscle contractions with Oxford Scale 3, 4, or 5 strengths. Increased age, parity, and stage of prolapse were associated with lower Oxford scores. Although most women with pelvic floor disorders are familiar with PMEs, less than one fourth could perform adequate contractions at the time of initial evaluation.

Abdominal and Pelvic Floor Muscle Function in Women With and Without Long Lasting Pelvic Girdle Pain.

Abdominal and Pelvic Floor Muscle Function in Women With and Without Long Lasting Pelvic Girdle Pain.

Cystometric urine stream interruption test in women with urodynamic stress incontinence

SummaryUrine stream interruption test (UST) is one of the subjective means of assessing pelvic floor muscle strength. This is done with the belief that most women with stress urinary incontinence cannot interrupt the flow of urine stream due to weak pelvic floor muscles. It is also used by some to monitor pelvic floor muscle strength following treatment. Our study looked at a cohort of 104 women with stress urinary incontinence and to our knowledge, our study is the first to use UST in women who have had their stress urine incontinence confirmed on urodynamics. We found that 87% of those with urodynamic stress incontinence (USI) were able to perform this test (UST). We therefore concluded that UST is a poor index of pelvic floor muscle function in women with USI and cannot be relied upon to monitor success of treatment in these women.

Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain

Approximately 5–20% of postpartum women suffer from long-lasting pelvic girdle pain (PGP). The etiology and pathogenesis of PGP are still unclear. The aim of this study was to examine whether subjects with and without persisting PGP and disability differed with respect to their ability to voluntarily contract the deep abdominals (TrA and IO) and to the strength of the pelvic floor muscles (PFM). Twenty subjects (12 with persisting PGP, 8 recovered from PGP) were examined. Contractions of the deep abdominal muscles (TrA and IO) were imaged by real-time ultrasound. Vaginal palpation and observation were used to assess the women's ability to perform correct a PFM contraction. PFM strength was measured by a vaginal balloon catheter connected to a pressure transducer. The active straight leg raise test was used to assess the ability of load transfer. The results showed no statistical significant difference between the groups in increase of muscle thickness of the deep abdominal muscles (TrA; P = 0.87 and IO; P = 0.51 ) or regarding PFM strength ( P = 0.94 ). The ability to voluntarily contract the deep abdominal muscles and the strength of the PFMs are apparently not associated to PGP. However, the results are based on a small sample and additional studies are needed.

Poster 18: Pelvic Floor Muscle Function in Women with Prolapse

Poster 18: Pelvic Floor Muscle Function in Women with Prolapse