Floor Muscles In Women Research Articles

EFFECTIVENESS OF HYPOPRESSIVE EXERCISES ON POSTNATAL MOTHERS WITH URINARY INCONTINENCE-A PILOT STUDY.

Background: Pelvic Floor Muscle Dysfunctions can lead to Urinary Incontinence, a condition which often affects women both during pregnancy and after childbirth. As a result of this, certain exercises are recommended during and after pregnancy to prevent and treat this incontinence. Hypopressive Exercise is one of these methods used to prevent Urinary Incontinence. Objective: The purpose of the study is to find the Effectiveness of Hypopressive Exercises on Postnatal Mothers with Urinary Incontinence. Methods: 30 Mothers (between the age group of 25 – 35 years) clinically pre diagnosed with urinary incontinence with PERFECT score were included in the study. with informed consent, the protocol was explained to the subjects. Mothers were given Hypopressive Exercises for 3 sessions per week for 4 weeks. This session lasted between 30 to 40 minutes. The outcome measure of the Exercises was measured using UI – QUID and PERFECT test. Results were tabulated using statistical analysis. Result: The analysis shows that the mothers who underwent Hypopressive exercises have significant reduction in urinary incontinence (p-value) P<0.0001. Conclusion: This study concluded that the mothers underwent Hypopressive exercises have significant reduction in Urinary Incontinence and increase in Pelvic Floor Muscle Strength Implications: The Hypopressive Exercises strengthens the Deep Core Muscles which increases body awareness by training the Pelvic Floor Muscles in women and reduces Urinary Incontinence. These Exercises not only pay attention to maintaining proper body posture and Pelvic Floor Muscles activation. But also had a positive impact on the Quality of Life and reduction of incidents of urine leakage among mothers.

Urinary disorders in patients diagnosed with organic brain pathology

Introduction. This study is relevant due to the high prevalence of organic brain pathology and the negative influence of urination disorders on the quality of life.Objective. To analyse the impaired function of lower urinary tracts in patients with organic brain pathology.Materials & methods. We analysed 607 patients with severe organic brain pathology (105 had traumatic spinal cord injury (TSCI) and 457 had consequences of acute stroke (AS)). We performed clinical urological examinations. During the survey, attention was paid to the presence of urinary tract pathology at the examining time and anamnesis. Structural changes in the urinary tract were objectively assessed. We objectively assessed structural changes in urinary tracts including prostate adenoma in men, insufficiency of pelvic floor muscles in women and strictures of the urethra or ureters. The degree of the spastic syndrome was assessed with the Ashworth Scale. The neurourological examination included cystometry with the measurement of bladder volume and post-void residual urine. The cognitive status of the patients was assessed with the MMSE (Mini-Mental State Examination) questionnaire. The correlation analysis between the degree of spastic syndrome measured with the Ashworth Scale and urination disorders was performed with Spearman rank correlation.Results. All patients had neurogenic dysfunction of the lower urinary tract. A combination of bladder retention and emptying disorders was found in 62 men older than 45yo with benign prostate hyperplasia (10,2% of all cases). An impaired accumulation function in history was found in 45 women older than 45yo (7,4% of all observations). The level of spasticity was 3 or 4 points on the Ashworth Scale in patients with TSCI and 2 to 4 points in those with AS. The analysis of correlations between the degree of spasticity and urination disorders showed a moderate relationship (r = 0,4) in patients with TSCI and a medium relationship (r = 0.65) in patients with AS.Conclusion. Neurogenic dysfunction of the lower urinary tract accompanies patients with severe organic brain pathology throughout their life and requires adequate correction.

Ultrasound Morphometry of the Pelvic Floor Muscles in Women of Reproductive Age

Biometric studies in nulliparous women conducted to date are limited by small sample sizes. The pelvic floor muscles perform an important function throughout a woman’s life. They provide fixation and maintenance of the pelvic organs, stretches during childbirth, ensuring the formation of the birth canal, and are a potential site for the formation of a hernia in the female body. Impaired function of this muscle group can lead to either excessive muscle contraction (chronic pelvic pain syndrome) or excessive stretching (pelvic organ prolapse). The purpose of the study is to assess the morphometric properties of the pelvic floor muscles in nulliparous women using 3D ultrasound scanning (sonography). Material and methods. The observation group consisted of 60 women of middle reproductive age who applied for an appointment with an obstetriciangynecologist with complaints of pain of various types localized in the perineum and pelvis, decreased desire and quality of sexual life, clinically confirmed by a diagnosis of incompetence of the pelvic floor muscles. The control group consisted of 30 women without dysfunction of the pelvic floor muscles according to clinical examination. The main criterion for inclusion of patients in the study was reproductive age - 18–45 years and natural childbirth in obstetric and gynecological history. Results. We found that the absence of visible sonographic markers of changes in the myofascial structures of the pelvis is not a prognostically significant criterion for muscle dysfunction, since predominantly changes in morphometric parameters are a reliable sign of the formation of pelvic floor muscle failure. Conclusion. The ultrasound morphometry method, which allows one to assess dynamic changes in the size of muscle and fascial structures, can be used in the clinical practice of an obstetrician-gynecologist. Early diagnosis of a violation of the structure of pelvis myofascial complex will allow early implementation of measures aimed at prevention and timely treatment.

Strengthening the pelvic floor in Female Sexual Dysfunctions: review

Background: Pelvic floor muscle strength and sexual function in women are important variables in Pelvic Physiotherapy. Aims: To identify the main contributions of Physiotherapy to strengthening the pelvic floor muscles in women. Method: Bibliographical review of books, scientific articles, theses and dissertations published between 2007 and 2023. Results: The pelvic floor is a muscular and ligamentous structure that supports the organs in the lower abdomen. Its weakness can cause a variety of problems, including UI, prolapse, pain, and sexual dysfunction. Pelvic Physiotherapy works to rehabilitate these problems. Its exercises aim to strengthen and relax the muscles, normalizing tone and desensitizing the genital region. In the long term, they restore function, helping women to have a more satisfactory sex life. Conclusion: Muscle strengthening, proprioception and body awareness exercises can help improve the quality of sexual life, making it more satisfying.

НЕКОТОРЫЕ АСПЕКТЫ ДИАГНОСТИКИ И ПРОФИЛАКТИКИ НЕДОСТАТОЧНОСТИ ТАЗОВОГО ДНА У ЖЕНЩИН РЕПРОДУКТИВНОГО ВОЗРАСТА

The aim of the study: to assess the significance of the study of the state of the pelvic floor in women of reproductive age who have risk factors for the development of pelvic organ plolapse; to evaluate the effectiveness of an electric exercise machine in combination with Kegel exercises in the preven-tion of pelvic organ prolapse. Matherial and methods: 363 women with a history of vaginal childbirth were examined, which, depending on parity and body mass index, were divided into 4 groups. Ultra-sound measurement of the height of the tendon center of the perineum, the width of the muscle bun-dles of the levator legs (m. bulbospongiosus, m. bulbocavernosus), the angle of urethral incline (alpha angle), vesico-urethral angle (betta angle), the length of the urethra was performed. The results of the study: obtained indicate the expediency of performing ultrasound scans with study of the muscles that form the pelvic floor in women who gave birth with perineal trauma, for early detection of pelvic floor insolvency. The effectiveness of using electric exercise machines in combination with a set of physical exercises to strengthen the pelvic floor muscles in women with preclinical manifestations of pelvic floor muscle failure has been proven.

НЕКОТОРЫЕ АСПЕКТЫ ДИАГНОСТИКИ И ПРОФИЛАКТИКИ НЕДОСТАТОЧНОСТИ ТАЗОВОГО ДНА У ЖЕНЩИН РЕПРОДУКТИВНОГО ВОЗРАСТА

The aim of the study: to assess the significance of the study of the state of the pelvic floor in women of reproductive age who have risk factors for the development of pelvic organ plolapse; to evaluate the effectiveness of an electric exercise machine in combination with Kegel exercises in the preven-tion of pelvic organ prolapse. Matherial and methods: 363 women with a history of vaginal childbirth were examined, which, depending on parity and body mass index, were divided into 4 groups. Ultra-sound measurement of the height of the tendon center of the perineum, the width of the muscle bun-dles of the levator legs (m. bulbospongiosus, m. bulbocavernosus), the angle of urethral incline (alpha angle), vesico-urethral angle (betta angle), the length of the urethra was performed. The results of the study: obtained indicate the expediency of performing ultrasound scans with study of the muscles that form the pelvic floor in women who gave birth with perineal trauma, for early detection of pelvic floor insolvency. The effectiveness of using electric exercise machines in combination with a set of physical exercises to strengthen the pelvic floor muscles in women with preclinical manifestations of pelvic floor muscle failure has been proven.

Ferrostatin-1 alleviates the damage of C2C12 myoblast and mouse pelvic floor muscle induced by mechanical trauma

Ferroptosis is a special form of regulated cell death, which is reported to play an important role in a variety of traumatic diseases by promoting lipid peroxidation and devastating cell membrane structure. Pelvic floor dysfunction (PFD) is a kind of disease affecting the quality and health of many women’s lives, which is closely related to the injury of the pelvic floor muscle. Clinical findings have discovered that there is anomalous oxidative damage to the pelvic floor muscle in women with PFD caused by mechanical trauma, but the specific mechanism is still unclear. In this study, we explored the role of ferroptosis-associated oxidative mechanisms in mechanical stretching-induced pelvic floor muscle injury, and whether obesity predisposed pelvic floor muscle to ferroptosis from mechanical injury. Our results, in vitro, showed that mechanical stretch could induce oxidative damage to myoblasts and trigger ferroptosis. In addition, glutathione peroxidase 4 (GPX4) down-regulation and 15-lipoxygenase 1(15LOX-1) up-regulation exhibited the same variational characteristics as ferroptosis, which was much more pronounced in palmitic acid (PA)-treated myoblasts. Furthermore, ferroptosis induced by mechanical stretch could be rescued by ferroptosis inhibitor (ferrostatin-1). More importantly, in vivo, we found that the mitochondria of pelvic floor muscle shrank, which were consistent with the mitochondrial morphology of ferroptosis, and GPX4 and 15LOX-1 showed the same change observed in cells. In conclusion, our data suggest ferroptosis is involved in the injury of the pelvic floor muscle caused by mechanical stretching, and provide a novel insight for PFD therapy.

Gamma-band Intermuscular Connectivity Is Associated With Increased Neural Drive to Pelvic Floor Muscles in Women With Interstitial Cystitis/Bladder Pain Syndrome.

Interstitial cystitis/bladder pain syndrome patients can experience overactive pelvic floor muscle activity at rest. While the frequency power spectrum of pelvic floor muscle has briefly been explored, intermuscular connectivity of the pelvic floor muscle has yet to be studied, which may provide useful insight into the neurological component, ie, neural drive to muscles, in interstitial cystitis/bladder pain syndrome. High-density surface electromyography was collected from 15 female interstitial cystitis/bladder pain syndrome patients with pelvic floor tenderness and 15 urologically healthy female controls. Intermuscular connectivity was calculated across the maximally active locations of the left and right sides of the pelvic floor muscle as identified from the root mean squared amplitude at rest and compared with Student t tests for common sensorimotor rhythms involved in motor control: alpha (8-12 Hz), beta (13-30 Hz), and gamma (31-70 Hz) frequency bands. The root mean squared amplitudes at rest were also compared across groups. The resting root mean squared amplitude of the pelvic floor muscle was significantly greater in female interstitial cystitis/bladder pain syndrome patients compared to healthy female controls (P = .0046). The gamma-band intermuscular connectivity was significantly different between rest and pelvic floor muscle contraction (P = .0001) for healthy female controls, but not for female patients with interstitial cystitis/bladder pain syndrome (P = .1214). Both results indicate an elevated neural drive to pelvic floor muscle at rest in female interstitial cystitis/bladder pain syndrome patients. Gamma-band pelvic floor muscle connectivity in female interstitial cystitis/bladder pain syndrome patients is increased at rest. The results of this study may provide insight into the impaired neural drive to pelvic floor muscle implicated with interstitial cystitis/bladder pain syndrome.

Exercise Position to Improve Synergy Between the Diaphragm and Pelvic Floor Muscles in Women With Pelvic Floor Dysfunction: A Cross Sectional Study

ObjectiveThis 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. MethodsThe 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. ResultsThe 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). ConclusionThe 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.

Failure of Pelvic Floor Muscles in Women of Reproductive Age

To date, the problem of genital prolapse remains relevant due to the high incidence of this disease. Prolapse today is becoming one of the serious problems of gynecology, attention to which is increasing every year. In modern domestic and foreign literature, there are quite contradictory data on the frequency of pelvic organ prolapse (from 4.5 to 30% in the population). In recent years, a significant increase in the number of patients suffering from genital prolapse has been recorded worldwide. It is known that not all women who have anatomical changes in the supporting apparatus of the pelvic floor seek medical help. This article discusses the prevalence of pelvic organ prolapse, identified by questioning and, further, confirmed during a gynecological examination. The questionnaire has a proven effectiveness in detecting the disease in its early stages. In the structure of complaints, according to the survey, more than half of women with genital prolapse (62.3%) noted urinary incontinence. Dyspareunia bothered 52.2% of women, pelvic pain — 48.3% of the respondents. The article presents a number of functional tests that provide early diagnosis of genital prolapse and the choice of an appropriate approach in the treatment of this pathology.

Pelvic floor muscle strength in women with diabetes

Introduction and Aim: Diabetes mellitus (DM) is a global health problem with increasing prevalence linked to the alterations in the lifestyle, growing obesity rates and ageing. Women with insulin resistance (IR)/high insulin levels have worse electromyographic activity in the PFMs than women without IR/high insulin levels which prove the effect of IR/high insulin levels on PFMs. This study aimed at assessing and strengthening the pelvic floor muscles in women with diabetes and urinary incontinence. Materials and Methods: The subjects were diabetic women of age group 45-55 with urinary incontinence assigned to one of two groups namely the group A (experimental group) and the group B (control group) which consisted of 30 patients each. The strength of the pelvic floor muscle was measured by vaginal examination prior and after the treatment and a Kegels Perineometer was inserted to measure the Strength of contraction (MOS), Length of hold (s), Repetitions (n) and Fast contractions (n) for both the groups. Experimental group was advised to do pelvic floor strengthening exercises in various positions with differing durations and increasing repetitions while control group received the regular physiotherapy care. Results: The results revealed that there was significant increase in the pelvic floor strengths in both the groups but while comparing the post test results of both the groups there was a significant higher strength of contraction, length of hold, repetitions and fast contractions scores in experimental group. Conclusion: It is evident from the study that performing the pelvic floor strengthening exercises in various positions as in the experimental group exhibited more improved post test results which proved to show reduced symptoms of urinary incontinence and improved quality of life than that of the subjects in the control group.

THE MECHANISM OF URINARY CONTROL AND OPERATIONS OF SYNTHETIC SLING

Background: Over the past two decades, synthetic loop surgeries have gained widespread popularity due to their ease of implementation, relatively high efficiency and low cost in the treatment of women with stress urinary incontinence (SUI). To date, several dozen variants of minimally invasive surgical procedures are known, but none of the known methods provides a 100% reliable result. At the same time, the effectiveness of the performed operation to eliminate involuntary loss of urine is inexorably reduced in the follow-up.Aims of the study. On the basis of a neuroregulatory theory published in 2019 and according to a neurophysiological model, provide an explanation for both the mechanism of urinary retention and the role of the tape implanted under the urethra in its recovery.Material and methods. Analysis of a large number of foreign and domestic literary sources, the results of clinical observations of surgery using the original author's version of the trocar synthetic sling (TSS) for 19 years, the data of the original method of uroflowmetric monitoring.Results. Taking into account the created and published theoretical basis, an explanation is presented for the effect of increasing the tone of the pelvic floor muscles in women with urinary incontinence after surgical correction using modern synthetic materials.Conclusions. The restoration of the mechanism of urinary retention in women after the operation of a synthetic sling occurs under the condition of activation of the 4th mictional reflex. In the event of a violation of the components of this reflex, the effectiveness of the sling procedure decreases and a recurrent form of the disease occurs, regardless of the type and volume of the operation used. The presence of a theoretical basis that explains both the mechanism of urinary retention itself and the pathogenesis of the development of the disease allows us to offer options for conservative therapy to prepare for the sling procedure and thereby increase the follow-up efficiency of any loop surgery.

Comparison of the Effect of Osteopathic Manipulations and Exercises on the Myoelectric Activity of the Pelvic Floor: A Randomized Controlled Trial

ObjectiveThe purpose of this clinical trial was to compare the effects of 4 different interventions on electromyographic activity of the pelvic floor muscles in women with stress urinary incontinence (UI). MethodsFifty-one women with stress UI were randomized into 4 groups: a global osteopathic protocol (myofascial, visceral, and articular techniques); 1 manipulation technique (high-velocity, low-amplitude/thrust) of the sacroiliac joint and T10-L2; training of the pelvic floor muscles; and no intervention (control). Electromyographic activity of the pelvic floor muscles was evaluated at 5 different times (baseline, immediately after the procedure, 30 minutes, 1 hour, and 4 weeks after intervention). ResultsForty women completed the study. There were no immediate or late effects on the myoelectric activity of any type of muscle fiber in any of the groups analyzed. ConclusionThere were no significant between-groups differences of electromyography in women with symptoms of stress UI.

Absolute and Relative Reliability of the Assessment of the Muscle Mechanical Properties of Pelvic Floor Muscles in Women with and without Urinary Incontinence.

An analysis of the muscle mechanical properties (MMPs) of the pelvic floor muscles (PFMs) is relevant for understanding the physiopathology of urinary incontinence (UI). However, there is no objective and reliable methodology currently available for quantifying the MMPs of PFMs. Thus, the objective was to determine the intra-rater and inter-rater reliability of the MMPs of PFM assessment with a hand-held tonometer device, called the MyotonPRO, in young women with and without UI. Sociodemographic and pelvic floor questionnaires, plus MMPs of PFMs were assessed in 38 nulliparous women with UI and 40 matched healthy women by two trained physiotherapists on two different occasions, 48–72 h apart. Good to excellent absolute reliability was found for tone, stiffness, and decrement of both intra- and inter-rater analyses in both study groups (Intraclass Correlation Coefficient ranged from 0.75 to 0.92), with a trend of lower values for relaxation and creep. The standard error of measurement (SEM) did not achieve 10% of the mean values for any MMPs. The minimum detectable change (MDC) values were also provided for clinical applications. In conclusion, the relative reliability of tone, stiffness, and the assessment of the decrement of PFMs with MyotonPRO is good to excellent for UI and healthy women. The SEM and MDC values were acceptable for their application in clinical settings.

Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incontinence: study protocol for a randomized controlled trial with economic evaluation

IntroductionPelvic floor muscle training (PFMT) exercises and neuromuscular electrical stimulation (NMES) are described as conservative interventions to prevent or treat female stress urinary incontinence (SUI). However, it has not been described yet the effect of PFMT associated to intravaginal NMES which evaluated the cost-effectiveness and cost-utility of treating.AimsTo evaluate the effects of intravaginal NMES associated with the PFMT protocol on urinary loss and quality of life in women with SUI and to evaluate the cost-effectiveness and cost-utility and pelvic floor muscle in women with SUI.MethodsRandomized controlled trial study with economic evaluation. Inclusion criteria are woman (biological), aged ≥ 18 years old and with a report of SUI ≥ once/week. Exclusion criteria are presence of vaginal or urinary infection, virginity, being in the gestational or puerperium period, or neurological disease. Participants will undergo physical therapy assessment and intervention: anamnesis, pelvic floor muscle assessment by vaginal palpation and manometry (PeritronTM), questionnaires (Short-Form 6 Dimensions—Brazil (SF-6D), King's Health Questionnaire (KHQ) and King´s Health Questionnaire for Scoring Algorithm), health costs, and voiding diary. Participants will be randomly allocated into 3 groups: CG (control group), IG 1 (intervention group 1, PFMT), and IG2 (intervention group 2, PFMT + NMES). The statistical analysis will be performed by intention to treat, and multivariate analysis of mixed effects will be used to compare outcomes. Effect size measurements will be calculated and will be provided by Cohen’s d test. A significance level of 5% will be adopted. Additionally, the incremental cost-effectiveness and incremental cost-utility ratios will be used.DiscussionThis protocol can corroborate with the literature in order to identify the effect of techniques, based on the possibility of confirming the hypothesis that the NMES associated with PFMT performed concurrently will be the best treatment option; considering the effectiveness, cost-effectiveness, and cost-utility analysis, it will be used as an option for optimization of the treatment of SUI.Trial registrationBrazilian Registry of Clinical Trials (ReBEC) ID: RBR-6gtzg4. Registered on September 3, 2019.

Assessment of the effect of Mulabandha yoga therapy in healthy women, stigmatized for pelvic floor dysfunctions: A randomized controlled trial

BackgroundIn developing countries, women do not reveal their perineum related health issues because most of the time they are stigmatized by the society. Multiparity, mostly found in women of rural areas is one of the major causes of pelvic floor dysfunctions (PFDs) like pelvic organ prolapse, urinary incontinence, rectal incontinence, etc. Usually, they visit health centres in the advanced stage of diseases, and then medical treatment is not the only choice left. Many research studies show that yoga practices promote health conditions, contribute to enhancing endurance, flexibility, and muscular strength, and improving quality of life. Objective(s)The study was conducted to assess the impact of Mulabandha yoga therapy (MYT) in healthy woman participants as a preventive measure. Material and methodsThe study was a prospective and randomized controlled trial. Fifty healthy woman participants were allocated in two groups viz., MYT group and No MYT group. Mulabandha yoga was conducted for the MYT group for 12 weeks. No MYT group was advised not to do yoga. Pelvic floor muscle strength was internally evaluated by employing the PERFECT scheme score (P = power, E = endurance, R = repetitions, F = fast contractions, ECT = every contraction timed). For eligible samples, MYT sessions were held for 12 weeks. Data interpretation was done with SPSS software 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). ResultsFifty healthy woman participants were allocated for analysis. There was no statistically significant difference in between the groups comparison in terms of age, socio-economic status, occupation, education, parity and mode of delivery. PERFECT scheme score significantly improved in participants after 12 weeks of regular MYT. No statistically significant differences were observed between the groups comparison in terms of PERFECT scheme score. ConclusionThe current study shows that regular practice of MYT for 12 weeks is a better means to reinforce the strength of pelvic floor muscles in women. This MYT procedure will establish evidence for women who are reluctant towards their pelvic organ-related issues. Women must incorporate the MYT practice in their routine life as a preventive measure to refrain from pelvic floor dysfunctions.

Factors Associated With Myofascial Dysfunction of the Pelvic Floor Muscles in Women With Urinary Incontinence: A Cross-Sectional Study.

This study aimed to evaluate the prevalence and associated factors of pelvic floor myofascial dysfunction (PFMD) in women with urinary incontinence (UI). A cross-sectional study was performed. Pelvic floor myofascial dysfunction was defined by pain of any intensity during palpation of the pelvic floor muscles and strength assessed by the modified Oxford scale, and was classified in grade I (mild pain), grade II (moderate), and grade III (severe). Univariate and multivariate analyses were calculated (5% significance level) to seek for the associated factors of PFMD. A total of 234 women with UI were included, 121 women in the PFMD group and 113 in the control group. The mean ages were 52.1 ± 10.2 and 53 ± 8.1 years, respectively. Pelvic floor myofascial dysfunction was more frequent among non-White women, and women with PFMD presented more dyspareunia and recurrent urinary tract infection. There was a higher frequency of mixed UI (MUI; 89.2%) in the PFMD group and stress UI (31.9%) in the control group. The prevalence of PFMD was 51.7%, with 10.6% of patients categorized into grade I, 18.8% in grade II, and 22.2% in grade III. In women with PFMD, there is an inverse relation between pain and muscle strength, with the highest strength values (3, 4, and 5) being in grade I (P = 0.028). The multivariate analysis has shown that women with MUI had a risk 4.9 times greater (adjusted odds ratio, 4.93 [2.34-10.42]; P < 0.001) of having PFMD, and non-White women had a 2.1-fold increased risk (adjusted odds ratio, 2.07 [1.10-3.91]; P = 0.024) of presenting with PFMD. A high prevalence of PFMD was found among women with UI. Mixed UI and non-White race were the associated factors of PFMD.

Efeitos da ginástica hipopressiva no prolapso de órgãos pélvicos: Uma revisão integrativa

Introdução: A ginástica abdominal hipopressiva oferece benefícios no tratamento da fisioterapia para melhorar a pressão intra-abdominal do músculo diafragma, melhorar propriocepção perineal e a tonificação do músculo do assoalho pélvico nas mulheres. Objetivo: analisar os efeitos da ginástica hipopressiva como recurso de tratamento fisioterapêutico nos prolapsos de órgãos pélvicos em mulheres. Metodologia: Caracterizada como revisão integrativa da literatura através de uma abordagem descritiva e exploratória, utilizou - se para o levantamento dos dados bibliográficos a base de dados PEDro (Physiotherapy Evidence Database). Foram utilizados como critérios de inclusão para a pesquisa trabalhos científicos em língua portuguesa, inglesa e espanhola publicados entre 2009 e 2019 disponíveis online, na integra e de forma gratuita e como critérios de exclusão, artigos repetidos, que não possuíam resumo, e que não estavam acessíveis por completo, ou que não tinham nenhuma relação com a temática aqui estudada. Resultados e Discussão: Dentre os efeitos da ginástica hipopressiva no prolapso de órgãos pélvicos foi observado a atuação do treinamento muscular do assoalho pélvico (TMAP) que continua sendo o tratamento de primeira linha para a disfunção do assoalho pélvico. Considerações Finais: a ginástica hipopressiva é menos eficaz do que o treinamento muscular do assoalho pélvico para ativar os músculos do assoalho pélvico. Necessitando de sugestões de novos estudos que incluam outras técnicas para atuar no tratamento de prolapso de órgão pélvico.

The Prognostic Value of the Surface Electromyographic Assessment of Pelvic Floor Muscles in Women with Stress Urinary Incontinence.

Background: The use of surface electromyography (sEMG) measurements to evaluate the bioelectrical activity of the pelvic floor muscle (PFM) during therapeutic intervention is now well established. This study investigates the diagnostic possibilities of sEMG in women with stress urinary incontinence (SUI). The aim of this study was to carry out objective assessments of the bioelectrical activity of the PFM in women after menopause and determine the prognostic value of sEMG for assessing the PFM in patients with SUI. Methods: This was a prospective, observational study that evaluated the bioelectrical activity of the PFM in postmenopausal women with or without SUI (SUI group, n = 89 vs. non-SUI group, n = 62). The study was carried out between January 2013 and December 2018 at the Clinic of Urology (Wroclaw, Poland). The protocol for all sEMG measurements of PFM activity consisted of following elements: “baseline”, “quick flicks”, “contractions”, “static hold”, and “rest tone”; we then compared these results between groups. To determine the optimal cutoff level for sEMG activation of the PFM to detect the occurrence of SUI, we performed receiver operating characteristic (ROC) curve analysis (with Youden’s index). Results: Significantly lower results were obtained for all PFM measurements in women with SUI. The optimum diagnostic cutoff for “baseline” was 3.7 μV (area under curve (AUC), 0.63), “quick flicks” was 9.15 μV (AUC, 0.84), “contractions” was 11.33 μV (AUC, 0.80), “static hold” was 9.94 μV (AUC, 0.84), and “rest” was 3.89 μV (AUC, 0.63). Conclusions: Measuring sEMG activity in the PFM may be a useful diagnostic tool to confirm the absence of SUI. We can expect that the sEMG activity of subjects with SUI will be lower than that of healthy people. In order to determine appropriate reference values for assessing sEMG activity data in the PFM, it is now necessary to conduct multicenter studies.

Activation patterns of pelvic floor muscles in women with incontinence while running: a randomized controlled trial.

Running is known to cause urinary leakage in women with stress urinary incontinence (SUI). Task-specific fiber-type recruitment while running can be estimated using wavelets. The aim of this study was to compare the effect of a new physiotherapy program including involuntary, reflexive training with a standard physiotherapy program on pelvic floor muscle (PFM) activation patterns and fiber-type recruitment behavior while running. In this triple-blinded randomized controlled trial, women with SUI were randomly allocated to the control group (CON), which performed a standard physiotherapy program, or the experimental group (EXP), which received additional involuntary, reflexive training. PFM electromyography (EMG) was recorded during 10s at three running speeds and analyzed using Morse wavelets. The relative distribution of power (%) over the frequencies from 20 to 200Hz was extracted and analyzed within six-time intervals of 30ms. Statistical nonparametric mapping was performed to identify power spectra differences. Thirty-nine (CON) and 38 (EXP) women were included. The power spectra showed no statistically significant group differences. The time intervals from 30ms before to 30ms after initial contact showed significantly lower intensities than the intervals from 30 to 150ms after initial contact in the lowest and higher intensities in the highest frequencies for all running speeds and both groups. Power spectra shifts toward higher frequency bands in the pre-initial contact phase could indicate a feed-forward anticipation and a muscle tuning for the expected impact of initial contact event in order to maintain continence.