Pelvic Floor Muscle Endurance Research Articles

(072) Effect of Diafragmatic Breathing Exercises on Individual with Premature Ejaculation

Abstract Introduction Premature ejaculation (PE) is defined as an intravaginal ejaculation latency time (IELT) of less than 60 seconds and the most common sexual dysfunction among men. There is no published study researching the effect of diafragmatic breathing exercises (DBE) on PE and also no optimal training protocol has been identified. Objective Investigate the effect of DBE on PE and to create a new treatment protocol. Methods Sixty two men with PE aged between 20–45 years were included in the study and randomly divided into Group I or Group II (n=1:1). Both groups underwent the treatment protocol includes behavioral therapy (BT) and pelvic floor rehabilitation (PFR) in 4 steps: 1) awareness of the pelvic floor muscles (PFM), 2) PFM specific contraction, 3) using the BT for learning the timing of pre-orgasmic sensation and maintenance of PFM contraction during sensation of the pre-orgasm, 4) PFM strengthening exercises. PFM strengthening exercises were given 3 days/week, 2 times/day for 8 weeks. Group I also underwent DBE that were given as 3 s inspiration-7 s expiration, at least 10 times/session for each day, 2 sessions/day, for 8 weeks. For awareness and specific contraction of PFM, patient was asked to contract his PFM with the cue to stop to urine while performing a digital rectal examination in supine. In order to learn the timing of pre-orgasmic sensation, masturbation exercises were given to the patient with start-stop tecnique. During the cycle of the pre-orgasmic sensation contraction of PFM was requested. After 4 or 5 cycles the patient can let himself reach ejaculation. Result of this training discussed with the patient once a month by phone-call. PFM strengthening exercises comprised sustained for slow (10 s submax. contraction-10 s relaxation x15 times) and fast twitch muscle fibers (1 s contraction-10 s relaxation x10 times). Outcome measurements were made by a blinded assessor at pre-treatment and at the end of the 8 week (post-treatment). Stop watch was used to calculate IELT, Ultrasound was used to measure PFM strength (US-S) and PFM endurance (US-E) and Elite-HRV device was used to measure autonomic nervous system parameters (Root mean square of successive differences (RMSSD), proportion of NN50 (PNN50), Low frequency power (LF-Power), High frequency power (HF-power), Low frequency/high frequency ratio (LF/HF-ratio)). Results Twenty nine (mean age=31.4±6.5) in Group I and 30 (mean age=31.3±7.6) in Group II (total 59) completed the study. There was no significant difference between the groups in terms of demographic characteristics and pre-treatment IELT. Both groups showed significant improvement in all measurement parameters (all p<0.001), except LF/HF at post-treatment. When the differences between pre-treatment and posttreatment were compared, IELT (p=0.016), RMSDD (p<0.001), PNN50 (p=0.001), LF Power (p=0.001), HF Power (p=0.006), US-S (p<0.001), US-E (p<0.001) were significant in favor of Group I. Conclusions BT and PFR combined protocol, showed increase in IELT, PFM strentgh and endurance and improvements at autonomic nervous system parameters. Adding DBE to this protocol showed better improvements in all parameters. Disclosure No.

Effect of home-based core exercises on postpartum stress urinary incontinence during COVID-19 pandemic in Jeddah city: a randomised control trial

IntroductionIntroduction. Postpartum stress urinary incontinence affects many women worldwide; it may exist during pregnancy or postpartum with a risk of permanence increasing five years later. This study aimed to determine the effect of home-based core exercises on postpartum stress urinary incontinence during the COVID-19 pandemic, in Jeddah city.MethodsRandomised control trial was conducted on 26 postpartum women aged 25–40 years with mild or moderate grade stress urinary incontinence and a body mass index (BMI) less than 30 kg/m2. Participants were randomly divided into two equal groups (A & B). Group A performed home-based core exercises and pelvic floor muscle training for twenty-four sessions three times weekly for eight weeks; each session lasted 30 minutes. Group B performed home-based PFMT only. The assessment of pelvic floor muscles (PFMs) was measured with the Modified Oxford Grading Scale, while the 1-hour pad test and International Consolation on Incontinence questionnaire-short form (ICIQ UI- SF) total score served to assess incontinence severity before and after treatment.ResultsThe results showed a significant improvement in PFMs strength and endurance in both groups and there was a highly significant difference between groups, favouring the study group (A). There was a highly significant difference between the groups in the 1-hour pad test and ICIQ-SF total score, favouring the study group (A).ConclusionsHome-based core exercises for postpartum SUI women were an effective method to improve PFMs strength and endurance and minimise SUI symptoms.

Impact of preoperative pelvic floor muscle function on the success of surgical treatment of pelvic organ prolapse

Introduction and hypothesisThe objective of this study was to identify the potential characteristics of pelvic floor muscles (PFM) in the preoperative assessment that could be associated with post-surgical prolapse severity. We hypothesized that the same variables, if identified, could be addressed in preoperative rehabilitation to improve surgical results.MethodsThis was a single-center prospective observational study that included women who underwent surgical pelvic organ prolapse repair between 2020–2022. Genital prolapse was evaluated according to the Pelvic Organ Prolapse Quantification (POP-Q) system. All the participants underwent a PFM assessment, including a vaginal digital assessment and manometry (Peritron™ 9300 V) before surgery and at 1-, 3-, and 6-month follow-ups. Several PFM variables were recorded: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), area under the curve during a 10-second MVC, ability to correctly contract the PFMs, and reflexive activation during cough and relaxation. The primary endpoint of the analysis was objective surgical success defined as POP-Q 0 or 1 at the 6-month follow-up. Additionally, a change in pelvic floor muscle function was recorded during postoperative visits.ResultsA total of 106 females were included in the study. Fifty-one were lost during the 6-month follow-up, which is a major limitation of the study. None of the examined parameters evaluating PFM were associated with surgical success. No statistically significant difference was found in MVC and PFM endurance before and after surgery. Post-surgery, a significant change was observed in the vaginal resting pressure and the ability to correct PFM activation and relaxation.ConclusionsPreoperative PFM function is not associated with surgical success 6 months after surgery.

Analysis of multisite surface electromyography characteristics of pelvic floor muscles in postpartum patients with diastasis recti abdominis.

To explore the electrophysiological characteristics of the independent muscles in the pelvic floor muscle (PFM) group of postpartum women with diastasis recti abdominis (DRA) and analyze the correlation between the rectus abdominis interval and PFM function. A total of 133 women who underwent postpartum re-examination from August 2021 to July 2022 were collected. The participants were divided into DRA and control groups based on the occurrence of DRA on ultrasonography. General data of the participants were collected, and the multisite surface electromyography (sEMG) assessment of the PFMs was performed using a intravaginal novel airbag-type stretchable electrode array device developed by the team. The sEMG characteristics of the different PFMs in the two groups were compared, and the correlation between the maximum rectus abdominis interval and the sEMG parameters of different PFMs was analyzed. There were no differences in the baseline demographics and incidence of pelvic floor dysfunction between the two groups (p > 0.05). The mean amplitude of vaginal sphincter endurance contraction in the DRA group was significantly lower than that in the control group (28.44 ± 15.59 vs. 22.03 [12.22, 28.00], p < 0.05). Spearman's rank correlation analysis showed a weak negative correlation between the maximum rectus abdominis interval and the endurance contraction mean amplitude of the urethral and external anal sphincters (r = -0.173, -0.217, p < 0.05). Patients with DRA had weakened PFM endurance, and there was a weak negative correlation between the maximum rectus abdominis interval and the endurance contraction mean amplitude of the PFM.

Efcacy of Electrostimulation and Pelvic Floor Muscle Exercises in the Treatment of Stress Urinary Incontinence in Women: Randomised Controlled Trial

Background. Pelvic floor muscle training (PFMT) is the most commonly used physiotherapy method in the treatment of female stress incontinence; pelvic floor muscles (PFM) can be trained not only with exercise but also with electrostimulation. The aim. To determine the efcacy of four weeks of pelvic floor muscle exercises and electrical stimulation in the treatment of stress urinary incontinence in women. Methods. The study involved 24 subjects who were randomly divided into two groups: pelvic floor muscle training (PFMT) and pelvic floor muscle exercises combined with electrostimulation (PFMES). Before and after the interventions, women’s quality of life (QoL) was assessed according to the International Incontinence Counselling Questionnaire – Short Form. Perineometry with Pelvexiser perineometer was used to measure pelvic floor muscle strength, endurance and vaginal resting pressure. Results. Both interventions signifcantly reduced urinary incontinence episodes and improved the subjects’ quality of life. PFM strength improved after the interventions in the PFMT group from 12.33±3.37 to 19.97±3.38 mmHg (p=0.0008, d=2.26) and in the PFMES group from 8.31±2.41 to 11.84 ±2.78 mmHg (p=0.003, d=2.6). PFM endurance improved in the PFMT group from 3.50±1.15 to 4.53±1.12 s (p=0.03, d=0.9), and in PFMES from 2.92±0.47 to 3.67±0, 52 s (p=0.001, d=1.45). Resting vaginal pressure in the PFMT group improved from 5.3±0.85 to 6.44±1.03 mmHg (p=0.005, d=1.25) and in the PFMES group from 4.4±0.70 to 6.14± 1.47 mmHg (p=0.001, d=1.5). Conclusions. PFMT and PFMES interventions signifcantly improved subjects’ PMF strength, endurance, resting vaginal pressure, and quality of life. Both applied interventions can be applied in the treatment of stress urinary incontinence, as they were safe and well tolerated by the patients. The trial is registered at ClinicalTrials.gov Identifer: NCT05871281. Keywords: female, strength, endurance, incontinence, questionnaire.

Core Stabilization Exercise in Prenatal and Postnatal Women With Urinary Incontinence: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

The aim of the study is to evaluate the effect size of core stabilization exercise for prenatal and postnatal women through measures of urinary symptoms, voiding function, pelvic floor muscle strength and endurance, quality of life, and pain scores. The PubMed, Embase, Cochrane Library, and Scopus databases were searched. Randomized controlled trials were selected and subjected to meta-analysis and risk of bias assessment. Ten randomized controlled trials were selected, and 720 participants were included. Ten articles using seven outcomes were analyzed. Relative to the control groups, the core stabilization exercise groups exhibited superior results for urinary symptoms (standardized mean difference = -0.65, 95% confidence interval = -0.97 to 0.33), pelvic floor muscle strength (standardized mean difference = 0.96, 95% confidence interval = 0.53 to 1.39), pelvic floor muscle endurance (standardized mean difference = 0.71, 95% confidence interval = 0.26 to 1.16), quality of life (standardized mean difference = -0.9, 95% confidence interval = -1.23 to 0.58), transverse muscle strength (standardized mean difference = -0.45, 95% confidence interval = -0.9 to -0.01), and voiding function (standardized mean difference = -1.07, 95% confidence interval = -1.87 to 0.28). Core stabilization exercises are safe and beneficial for alleviating urinary symptoms, improving quality of life, strengthening pelvic floor muscles, and improving transverse muscle function in prenatal and postnatal women with urinary incontinence.

A novel radiofrequency modulation therapy versus routine physiotherapy modalities in treatment of myofascial pelvic pain syndrome: a pilot randomized trial.

The current study aimed to compare the effectiveness of novel radiofrequency modulation (RM) therapy with a tailored physiotherapy course for patients with chronic pelvic pain (CPP) of myofascial origin, also known as myofascial pelvic pain syndrome (MPPS). We enrolled 46 patients with myofascial CPP to compare the effectiveness of a 10-session routine physiotherapy course versus a 6-session RM with an integrated device (HIGGS) in alleviating MPPS morbidity and pelvic floor muscle (PFM) rehabilitation. The primary outcome was reduction in pelvic pain after the final session and in the follow-up period 3 months after the final intervention session. The 6-session therapy in the RM group and the manual, biofeedback, and transcutaneous electrical nerve stimulation therapies in the physiotherapy group were similarly effective in reducing pain and improving PFM endurance after the final intervention session in each group, whereas perineometer readings and PFM strength were associated with greater improvements in the physiotherapy group. The results of this study demonstrated comparable effectiveness of RM in the management of MPPS and improvement of PFM function compared to routine physiotherapy programs with fewer sessions of therapy.

Gestational diabetes mellitus and pelvic floor function 6 weeks postpartum in Chinese women.

With the significant increase in its incidence, gestational diabetes mellitus (GDM) has received growing attention for its effect on pelvic floor function. This study was aimed at investigating the association of GDM with pelvic floor function and diastasis recti abdominis (DRA) in postpartum women. This is a retrospective cohort study. At 6 weeks postpartum, 1,133 postpartum women with vaginal delivery underwent routine examinations including measurement of the pelvic floor muscle (PFM) strength and endurance, determination of the stress urinary incontinence (SUI) by questionnaire, quantification of pelvic organ prolapse (POP) and assessment of DRA. Statistical analysis was performed using binary logistic regression and multiple linear regression analysis. One hundred and seventy-six (176) of the 1,133 women were confirmed to be suffering from GDM, with a rate of 15.53% (176 out of 1,133). The age and pre-pregnancy body mass index of the GDM group were significantly higher than those without GDM (p < 0.05). The GDM group was more likely to have smaller gestational age and a higher chance of having to undergo a lateral episiotomy. No statistically significant differences are found in PFM endurance (B: -0.025, p = 0.462) or PFM strength (B: -0.001, p = 0.979) between women with and without GDM. And these two groups are not significantly different in terms of the prevalence of SUI (19.3% vs 20.4%), POP (35.8% vs 37.5%) and DRA (29.0% vs 25.8%; p > 0.05). Pelvic floor muscle function and SUI/POP/DRA prevalence of women at 6 weeks postpartum are not significantly affected by GDM.

Effects of Iyengar Yoga on Pelvic Floor Muscle Strength and Endurance among Young Females with Stress Urinary Incontinence

Objectives: To determine the effects of yoga therapy on pelvic floor muscle strength, endurance, and health-related quality of life in young women with stress urinary incontinence.&#x0D; Study Design: Interventional study (ClinicalTrials.gov Identifier: NCT04428853).&#x0D; Place and Duration of Study: Rehabilitation Department, Secondary Care Hospital, Karachi Pakistan, from Aug 2020 and Mar 2021.&#x0D; Methodology: A total of 44 young married females aged between 17 and 40 years, diagnosed with stress urinary incontinence due to pelvic floor muscle weakness, were included. Perineometer was used to assess the strength and endurance of pelvic floor muscles. In addition, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used to assess the impact of incontinence symptoms on quality of life and the outcome of treatment at baseline and after eight weeks of intervention.&#x0D; Results: Iyengar yoga significantly improved pelvic floor strength and endurance. There was statistically significance the impact of Iyengar yoga on pelvic floor muscle strength for the endurance of pelvic floor musculature (p &lt; 0.001). Similarly,Iyengar yoga was also found significantly effective in decreasing frequency, severity and overall quality of life (QoL) by improving scores of ICIQ-UI-SF questionnaires showing a pre-post mean difference of 10 (p &lt; 0.001).&#x0D; Conclusion: The current study indicated the important role of yoga in improving pelvic muscle strength and endurance and decreasing urinary incontinence symptoms and distress hence improving the quality of life.

Association between isokinetic abdominal muscle strength, pelvic floor muscle strength and stress urinary incontinence severity.

Studies have shown that there is co-activation between abdominal and pelvic floor muscles (PFM) in physiological conditions. This study aimed to assess pelvic floor and isokinetic trunk flexors function in non-active incontinent women, and to investigate the association between the strength of these muscle groups and the severity of stress urinary incontinence (SUI). A cross-sectional study was carried out. Twenty-five incontinent women were enrolled after one-hour pad test results and compared to twenty asymptomatic women. The severity of SUI was determined by the Pad test and Urinary Distress Inventory, Short Form (UDI-6). PFM function was assessed using the modified Oxford Scale, intra-vaginal PFM electromyography, and PFM endurance according to the PERFECT scheme. Trunk flexors strength was assessed using a Cybex Norm II dynamometer. Incontinent women had a weaker PFM and isokinetic abdominal muscle strength compared to continent women (P<0,05). SUI severity was negatively correlated with PFM strength (r=-0,620, P=0,001), isokinetic trunk flexors strength (r=-0,605, P=0,001), and PFM endurance (r=-0,561, P=0,003) in incontinent women. A positive correlation between PFM function and isokinetic trunk flexors strength was found in incontinent women (r=0,488, P=0,013). Non-active incontinent women had weaker pelvic floor muscles and isokinetic trunk flexors strength compared to continent ones. The positive correlation found between these two muscle groups may be explained by their synergic activity. These findings suggest that the severity of SUI could be related not only to PFM strength but also to abdominal muscle weakness. Further research is needed to recommend abdominal wall training as an alternative method to treat SUI. 3.

Recovery of pelvic floor muscle strength and endurance 6 and 12 months postpartum in primiparous women—a prospective cohort study

Introduction and hypothesisTo date there has been scant knowledge on the natural recovery of the pelvic floor muscles (PFMs) after childbirth. The aims of the present study were to investigate whether PFM variables at 6 and 12 months postpartum had returned to mid-pregnancy levels and assess risk factors for reduced recovery at 12 months postpartum.MethodsThis was a prospective cohort study following 235 nulliparous pregnant women from mid-pregnancy to 12 months postpartum. Vaginal resting pressure (VRP), PFM strength and endurance were assessed by manometry at 22 weeks, 6 and 12 months postpartum. Multiple linear regression was used to address factors influencing PFM variables beyond birth mode.ResultsCesarean section was protective for change in PFM variables. From mid-pregnancy to 12 months postpartum there was a 20% reduction in VRP (p<0.001) and a 7.5 % reduction in PFM strength (p=0.007), and an increase of 9% in PFM endurance (p=0.002) in the normal vaginal birth. The instrumental vaginal group had a decline in VRP of 21% (p<0.001) and PFM strength of 15% (p=0.011), but no significant change in PFM endurance. Higher BMI at 12 months postpartum, longer second stage of labor, and major tears of the levator ani muscle had a negative influence on the PFM recovery beyond delivery mode.ConclusionsAt 12 months postpartum following vaginal delivery, the PFMs are not fully recovered compared with mid-pregnancy values. More follow-up physical therapy may be warranted in the postpartum period, especially for women with complicated vaginal births and higher BMI.

Effect of prolonged second stage of labor on pelvic floor function: A prospective cohort study.

To evaluate the effect of the second stage of labor (SSL) lasting > 2 h on pelvic floor function. This single-center prospective cohort study included primiparous women with SSL > 2 h treated at Tongji Hospital between January 2018 and December 2019 (case group). A matched group of women with similar newborn weight and SSL < 2 h were recruited simultaneously (control group). Stress urinary incontinence (SUI) and pelvic floor muscle (PFM) characteristics were measured at 6 weeks, 6 months, and finally 1 year postpartum. A total of 63 pairs of primiparous women completed 1-year follow-up. The incidence of SUI in the case group was significantly higher than that in the control group at 6 weeks postpartum (P = 0.020); however, the differences were not significant at 1 year postpartum (P=1.00). PFM endurance was significantly lower in the case group at 6 weeks (P = 0.000), 6 months (P = 0.000), and 1 year (P = 0.011) after childbirth. There was no difference in PFM strength between the two groups. The maximal voluntary contraction (MVC) of PFM was significantly lower in the case group at 6 weeks postpartum (P = 0.007), but the differences were not significant at 1 year postpartum (P = 0.197). PFM endurance and MVC were higher at 1 year than at 6 weeks postpartum in both groups. The SSL > 2 h increased the incidence of SUI at 6 weeks postpartum and decreased PFM endurance for 1 year.

Pelvic floor muscle training and postural balance in elderly women: An exploratory single arm trial

IntroductionTo investigate the influence of a training of mobility, gait speed and postural balance of pelvic floor muscles (PFM). MethodsA single-arm clinical trial study was approved and registered at the Brazilian Clinical Trials Registry (RBR-4rxhd4). Eighteen women over the age of 60 with pelvic floor dysfunction complaints were subjected to 10 sessions of functional electrical stimulation and digital palpation of PFM. Mobility and gait speed were evaluated by the Timed up and Go and the 10-m walk tests respectively. Standing balance was evaluated using a force plate. ResultsNo significant differences were found in mobility, gait speed, and standing balance. PFM contraction worsened mobility, gait speed, and standing balance performance. ConclusionsThe training protocol enhanced PFM strength and endurance, but the improved ability to recruit PFM did not positively affect balance, mobility, and gait speed.

Can Supervised Pelvic Floor Muscle Training Through Gametherapy Relieve Urinary Incontinence Symptoms in Climacteric Women? A Feasibility Study.

To investigate the feasibility of pelvic floor muscle training (PFMT) through gametherapy for relieving urinary symptoms of climacteric women with stress or mixed urinary incontinence (UI). Randomized clinical trial, divided into two groups: Gametherapy (G_Game) and Control (G_Control). Both groups received recommendations about unsupervised PFMT, and G_Game also received supervised PFMT through gametherapy. After 5 consecutive weeks, the feasibility was investigated considering participant adherence, urinary symptoms (evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI-SF] questionnaire), and pelvic floor function (PERFECT Scheme: power, endurance, repetition and fast). The Fisher exact, Kruskal-Wallis, Wilcoxon sign paired, and Mann-Whitney U tests were used by intention-to-treat analysis, using STATA 15.1 (StataCorp, College Station, TX, USA) software. The present study included 20 women per group and observed a higher adherence in G_Game. In the intragroup analysis, a decrease in the ICIQ-UI-SF score was observed in both groups (14.0 to 10.0; 13.5 to 0), associated with increased endurance (2.5 to 3.5; 2.5 to 4.0) in G_Control and G_Game, respectively. Moreover, there was a concomitant increase in pelvic floor muscles (PFMs) power (2.0 to 3.0), repetition (3.0 to 5.0), and fast (10.0 to 10.0) in G_Game. In the intergroup analysis, a reduction of UI was observed (p < 0.001; r = 0.8), as well an increase in PFM power (p = 0.027, r = 0.2) and endurance (p = 0.033; r = 0.3) in G_Game. The feasibility of supervised PFMT through gametherapy was identified by observing participant adherence, relief of urinary symptoms, and improvement in PFM function.

Reliability, validity and responsiveness of pelvic floor muscle surface electromyography and manometry.

Vaginal surface electromyography (sEMG) is commonly used to assess pelvic floor muscle (PFM) function and dysfunction but there is a lack of studies regarding the assessment properties. The aim of the study was to test the hypotheses that sEMG has good test-retest intratester reliability, good criterion validity and is responsive to changes compared to manometry. PFM resting tone, maximum voluntary contraction (MVC) and endurance were measured in 66 women with pelvic floor dysfunction. One assessment by manometry was followed by two testing sessions with sEMG at baseline. After 4 to 42weeks of supervised PFM strength training, 29 participants were retested with both devices. Median age of the participants was 41years (range 24-83) and parity 2 (range 0-10). Very good test-retest intratester reliability was found for all three sEMG measurements. The correlation between sEMG and manometry was moderate for vaginal resting tone (r = 0.42, n= 66, p< 0.001) and strong for MVC (r = 0.66, n = 66, p < 0.001) and endurance (r = 0.67, n = 66, p < 0.001). Following the strength training period, participants demonstrated increased MVC and endurance measured with manometry, but not with sEMG. A significant reduction in resting tone was found only with sEMG. sEMG is reliable and correlates well with manometry. However, sEMG is not as responsive as manometry for changes in PFM MVC and endurance. For measurement of PFM resting tone, sEMG seems more responsive than manometry, but this requires further investigation.

Comparison of urinary incontinence, based on pelvic floor and abdominal muscle strength, between nulliparous female athletes and non-athletes: A secondary analysis.

To compare the strength of abdominal and pelvic floor muscles (PFM) between nulliparous female athletes (FAs) and non-athletes (FNAs), to determine the frequency of urinary incontinence (UI) in these groups. This cross-sectional comparative study of nulliparous women included 39 professional FAs, who competed at the district level or above, and 34 FNAs. Participants underwent pelvic floor and abdominal muscle assessments. PFM function and strength were assessed using the modified Oxford scale and a manometer (PERINA 996-2 QUARK). Abdominal muscle function and strength were assessed using a 4-Pro isokinetic dynamometer. The International Consultation on Incontinence Questionnaire-Short Form was used to assess UI symptoms among the athletes, and the International Physical Activity Questionnaire-Short Form was used to establish the level of physical activity among the non-athletes. The prevalence of UIs in the FAs was 53.8%, while that for FNAs was 35.3%. There was no association between being an athlete and having UI (p = 0.112). FAs were found to weigh more (p = 0.012) and have increased abdominal muscle strength (p = 0.014) and maximum voluntary PFM contraction as recorded by the manometer (p = 0.035), as well as a decreased PFM contraction endurance time (p = 0.025) than FNAs. FAs had stronger abdominal muscles and PFM contraction, as assessed by a manometer, but less PFM endurance when compared to FNAs. Despite these differences, the prevalence of UI was similar between groups.

Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence.

IntroductionThe pelvic floor muscle (PFM) could affect female sexual functions. The hip muscles are morphologically and functionally linked to PFM and are important elements of female sexual attraction.AimTo determine the relationship between female sexual function and hip muscle strength and PFM functions in women with stress urinary incontinence (SUI).MethodsA total of 42 women with SUI were recruited in this study. Female sexual function was measured using the pelvic organ prolapse urinary incontinence sexual function questionnaire (PISQ). PFM functions were measured using a perineometer. Hip muscle strength was measured using a Smart KEMA tension sensor. The relationship between female sexual function and PFM function and hip muscle strength was assessed using Pearson correlation coefficients and multiple regression analyses with forward selection.Main Outcome MeasuresPISQ score, PFM functions (strength and endurance), and strength of hip extensor, abductor, and adductor were the main outcome measures.ResultsFor the behavioral/emotive domain in the PISQ, hip extensor strength (r = 0.452), PFM strength (r = 0.441), PFM endurance (r = 0.362), and hip adductor strength (r = 0.324) were significantly correlated and hip extensor strength emerged in multiple regression. For the physical domain in the PISQ, hip abductor strength (r = 0.417), PFM endurance (r = 0.356), hip adductor strength (r = 0.332), and PFM strength (r = 0.322) were significantly correlated and hip abductor strength entered in multiple regression. For partner-related domain in the PISQ, hip adductor (r = 0.386) and abductor strength (r = 0.314) were significantly correlated and hip adductor strength appeared in multiple regression. For the PISQ total score, hip extensor strength (r = 0.484), PFM endurance (r = 0.470), hip adductor strength (r = 0.424), hip abductor strength (r = 0.393), and PFM strength (r = 0.387) were significantly correlated and hip extensor strength and PFM endurance emerged in multiple regression.ConclusionThe female sexual function could be related to not only PFM functions but also hip muscle strength in women with SUI. Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021;9:100325.

Efficacy of pelvic floor muscle training in improving symptoms of urinary incontinence and health related quality of life among parous and nulliparous women

Abstract Objectives To compare pelvic floor muscle strength, severity of urinary incontinence symptoms and health related quality of life between parous and nulliparous women; and to investigate the efficacy of pelvic floor muscle training in improving symptoms of urinary incontinence and health related quality of life in the previously mentioned two groups. Materials and methods Initially, 67 women were included in the study. Pelvic floor muscle strength and endurance were evaluated pre-treatment using the Pelvic floor exerciser. Participants were assessed before and after 10 weeks of pelvic floor muscle training by using The International Consultation of Incontinence Questionnaire – Short Form for symptoms severity, and The King’s Health Questionnaire for health related quality of life. Results The final sample included 32 participants: sixteen parous and sixteen nulliparous women between 18 and 50 years of age. Before the intervention, parous women (75%) were 2 times more likely to report urinary incontinence than nulliparous women (37.5%). They also had significantly lower pelvic floor muscle strength (p=.001), pelvic floor muscle endurance (p=.001), and more severe symptoms related to urinary incontinence (p=.009). Additionally, parous women had poorer disease specific quality of life in all domains. After the intervention, symptoms severity scores decreased significantly among both parous (p=.007) and nulliparous women (p=.038). Regarding quality of life, both groups had major improvements in all domains. Conclusions Our results suggest that urinary incontinence is more common among parous women. They experience more severe symptoms and have lower health related quality of life. Additionally, pelvic floor muscle training seems to be effective for improving symptoms of urinary incontinence and health related quality of life among both parous and nulliparous women.

Is There a Correlation between the Pelvic Floor Muscle Functions and the Strength of the Hip Muscles in Female with Stress Urinary Incontinence?

Background Because the hip muscles could affect pelvic floor muscle (PFM) function and tension of endopelvic fascia, contraction of hip muscles has been applied for stress urinary incontinence (SUI) intervention as co-contraction between hip muscles and PFM. Purpose The purpose of current study was to confirm the relationship between hip muscles strength and PFM functions in female with SUI. Study design Cross sectional study Methods Thirty-three female with SUI were recruited for the present study. PFM strength and endurance were measured by perineometer (unit: mmHg). Hip extensor, abductor, adductor and gluteal squeeze strength were measured by Smart KEMA tension sensor (unit: kg/body weight). The significance of the correlations between hip muscles strength and PFM functions were assessed using Pearson correlation coefficients. Results There were not significant correlations between PFM functions (strength and endurance) and hip extensor, abductor, adductor and gluteal squeeze strength. Conclusions These findings could indicate the difficulty of co-contraction of hip abductor, adductor, extensor and gluteal squeeze with PFM in female with SUI, which is caused by PFM dysfunction.

Relación entre dismenorrea y síndrome de dolor miofascial. Perspectiva desde la fisioterapia. Estudio piloto aleatorizado

The term dysmenorrhoea defines different symptoms that women can feel during menstruation, the most common being intense pain. Myofascial pain syndrome (MPS) is the combination of signs and symptoms caused by myofascial trigger points (MTP), at their site or at a distance. Therefore, the objective of this study is to evaluate the efficacy of a treatment for MTP in the abdominal, hip adductor and pelvic floor muscles, from a physiotherapeutic approach, regarding the following outcome measures: pain, sexual function, quality of life, strength and mobility in patients suffering from dysmenorrhoea. Materials and methodsRandomized pilot study. Participants were divided into two groups: A (n = 6), where dry needling and manual therapy was applied to the abdominal, hip adductor and pelvic floor muscles; and B (n = 7), where the participants received thermotherapy and stretching of these muscles. The outcome measures studied were menstrual pain, sexual function, quality of life, hip abduction range of motion, strength of the affected muscles, pelvic floor muscle endurance and finding myofascial trigger points. All the treatments were provided by the same physiotherapist, while a different physiotherapist carried out the evaluations blinded to each patient's group. Resultsin group A, a clinically (1.6 less in VAS) and statistically significant reduction (p = 0.018) in pain was observed in comparison with group B (.4 in VAS, p > 0.05). Quality of life also improved in the first group (p< 0.05). No further significant differences were found in the remaining outcome measures. Conclusionsa significant improvement was observed with regards to pain and quality of life in group A. Thus, we consider that specific treatment for MPS could be more clinically effective.We conclude that this research should be continued with a larger sample of participants, in order to clarify the efficacy of the physiotherapy treatment suggested for the remaining outcome measures.