Pelvic Floor Muscles In Women Research Articles

Assessment of pelvic floor muscles in women with deep endometriosis.

To assess function and prevalence of spasms and trigger points of the pelvic floor muscles in women with deep endometriosis. One hundred and four (104) patients were assessed. Group 1 (G1) was composed of 52 subjects diagnosed with deep endometriosis proven by magnetic resonance imaging (MRI); Group 2 (G2) was composed of 52 women with no signs of endometriosis. Subjects from both G1 and G2 were seen at the Division of Pelvic Pain and Endometriosis and at Center for Prevention of Sexually Transmitted Diseases, both at Federal University of São Paulo (UNIFESP), respectively. A full physical therapy evaluation was carried out, including medical history, presence of dyspareunia and physical examination, which included detailed evaluation of pelvic floor muscles and occurrence of muscle spasm, trigger point and muscle function. The average age of the subjects in the study group was 36.4 and 30.9 years in the control group (p=0.002). A greater prevalence of deep dyspareunia was found in the subjects in the endometriosis group when compared to the control group (p=0.010). Women in G1 had higher prevalence of muscle spasms. In this group, 53.9% had spasms-compared to only 17.3% of women in G2 (p<0.001). On the other hand, no significant difference between the groups (p=0.153) was found while searching for the presence of trigger points. Women with deep endometriosis have increased prevalence of pelvic floor muscle spasms when compared to the control group.

Vibrating vaginal balls to improve pelvic floor muscle performance in women after childbirth: a protocol for a randomised controlled feasibility trial.

This paper presents a feasibility trial protocol the purpose of which is to prepare for a future randomised controlled trial to determine the effectiveness of vibrating vaginal pelvic floor training balls for postpartum pelvic floor muscle rehabilitation. Vibrating vaginal pelvic floor training balls are available in Austria to enhance women's pelvic floor muscles and thus prevent or treat urinary incontinence and other pelvic floor problems following childbirth. Nonetheless, there is currently little empirical knowledge to substantiate their use or assess their relative effectiveness in comparison to current standard care, which involves pelvic floor muscle exercises. Single blind, randomised controlled feasibility trial with two parallel groups. It is planned to recruit 56 postpartum women in Vienna, who will be randomised into one of two intervention groups to use either vibrating vaginal balls or a comparator pelvic floor muscle exercises for 12weeks. As this is a feasibility study, study design features (recruitment, selection, randomisation, intervention concordance, data collection methods and tools) will be assessed and participants' views and experiences will be surveyed. Tested outcome measures, collected before and after the intervention, will be pelvic floor muscle performance as reported by participants and measured by perineometry. Descriptive and inferential statistics and content analysis will serve the preparation of the future trial. The results of this feasibility trial will inform the design and conduct of a full randomised controlled trial and provide insight into the experiences of women regarding the interventions and study participation.

Is there a difference in the electromyographic activity of the pelvic floor muscles across the phases of the menstrual cycle?

[Purpose] To evaluate the electrical activity of the pelvic floor muscle in women during the follicular, ovulatory, and luteal phases of the menstrual cycle and its correlation with estradiol and total testosterone levels. [Subjects and Methods] This cross-sectional study involved 30 women with ovulatory menstrual cycles. Total testosterone and estradiol levels were measured and the muscle tone and maximum voluntary contraction of the pelvic floor muscles were evaluated using surface electromyography. [Results] Muscle tone was significantly lower during the follicular (21.1±3.3 μV) and ovulatory (27.1±5.9 μV) phases than the luteal phase (30.4±4.1 μV). The maximum voluntary contraction was not different across phases. The estradiol level on the 7th day of the menstrual cycle showed a strong positive correlation with muscle tone and maximum voluntary contraction, and the testosterone level was positively correlated with muscle tone on the 21st day. [Conclusion] Women have better muscle tone during the luteal phase. The muscle tone and maximum voluntary contraction were strongly correlated with the estradiol level on the 7th day, and the muscle tone was correlated with the testosterone level on the 21st day of the menstrual cycle. These findings suggest that hormonal fluctuations during the menstrual cycle alter pelvic floor muscle activity.

Morphometry of the Pelvic Floor Muscles in Women With and Without Provoked Vestibulodynia Using 4D Ultrasound

It has been suggested that pelvic floor muscles (PFMs) play an important role in provoked vestibulodynia (PVD) pathophysiology. Controversy in determining their exact contribution may be explained by methodological limitations related to the PFM assessment tools, specifically the pain elicited by the measurement itself, which may trigger a PFM reaction and introduce a strong bias. The aim of this study was to compare PFM morphometry in women suffering from PVD to asymptomatic healthy control women using a pain-free methodology, transperineal four-dimensional (4D) ultrasound. Fifty-one asymptomatic women and 49 women suffering from PVD were recruited. Diagnosis of PVD was confirmed by a gynecologist following a standardized examination. All the participants were nulliparous and had no other urogynecological conditions. The women were evaluated in a supine position at rest and during PFM maximal contraction. Transperineal 4D ultrasound, which consists of a probe applied on the surface of the perineum without any vaginal insertion, was used to assess PFM morphometry. Different parameters were assessed in sagittal and axial planes: anorectal angle, levator plate angle, displacement of the bladder neck, and levator hiatus area. The investigator analyzing the data was blinded to the clinical data. Women with PVD showed a significantly smaller levator hiatus area, a smaller anorectal angle, and a larger levator plate angle at rest compared with asymptomatic women, suggesting an increase in PFM tone. During PFM maximal contraction, smaller changes in levator hiatus area narrowing, displacement of the bladder neck, and changes of the anorectal and of the levator plate angles were found in women with PVD compared with controls, which may indicate poorer PFM strength and control. Using a reliable and pain-free methodology, this research provides sound evidence that women with PVD display differences in PFM morphometry suggesting increased tone and reduced strength.

The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence

To assess the effect of a weekly, short-term physical therapy intervention on the pelvic floor muscles and urinary incontinence (UI) among patients of the public health system. Quasi-experimental before-and-after study. Clinical history and function evaluation were performed using perineal bidigital maneuvers and perineometry. The intervention consisted of transvaginal electrical stimulation and pelvic floor kinesiotherapy. Data were analyzed using the paired t test or Wilcoxon signed-rank test, Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient. A value of P<0.05 was considered significant. Eight-two women 55.1±10.9 years-old were evaluated. Mixed urinary incontinence (MUI), stress urinary incontinence (SUI) and urge urinary incontinence (UUI) were observed in 52.4%, 36.6% and 11%, respectively. The length of UI was 6.0 years (3.0-10). Approximately 13.64 physical therapy sessions were held on average. There was no difference in perineometry measurements following the intervention (40.6±24.1 versus 41.7±25.4, P=0.098). Muscle function significantly increased (P<0.01) in the bidigital maneuver. The patients reported being continent or satisfied with the treatment in 88.9% of cases. The results demonstrated an increase in muscle function and the attainment of urinary continence or treatment satisfaction in most cases.

Comparison of active and passive forces of the pelvic floor muscles in women with and without stress urinary incontinence

The reduction of the pelvic floor muscles (PFM) strength is a major cause of stress urinary incontinence (SUI). To compare active and passive forces, and vaginal cavity aperture in continent and stress urinary incontinent women. The study included a total of thirty-two women, sixteen continent women (group 1--G1) and sixteen women with SUI (group 2--G2). To evaluate PFM passive and active forces in anteroposterior (sagittal plane) and left-right directions (frontal plane) a stainless steel specular dynamometer was used. The anteroposterior active strength for the continent women (mean±standard deviation) (0.3±0.2 N) was greater compared to the values found in the evaluation of incontinent women (0.1±0.1 N). The left-right active strength (G1=0.43±0.1 N; G2=0.40±0.1 N), the passive force (G1=1.1±0.2 N; G2=1.1±0.3 N) and the vaginal cavity aperture (G1=21±3 mm; G2=24±4 mm) did not differ between groups 1 and 2. The function evaluation of PFM showed that women with SUI had a lower anteroposterior active strength compared to continent women.

Assessment of the Pelvic Floor Muscles in Women with Sexual Pain

Assessment of the Pelvic Floor Muscles in Women with Sexual Pain

P639 Analysis of the pelvic floor muscle in women with different frequencies of sexual relation – A preliminary biomechanical study

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S596-S596 Poster presentations P639 Analysis of the pelvic floor muscle in women with different frequencies of sexual relation – A preliminary biomechanical study J. Santos, J. SantosSearch for more papers by this authorR. Xaubet, R. XaubetSearch for more papers by this authorL. Silva, L. SilvaSearch for more papers by this authorC. Amorim, C. AmorimSearch for more papers by this authorM. Dellu, M. DelluSearch for more papers by this authorA. Schmitt, A. SchmittSearch for more papers by this authorR. Soares, R. SoaresSearch for more papers by this author J. Santos, J. SantosSearch for more papers by this authorR. Xaubet, R. XaubetSearch for more papers by this authorL. Silva, L. SilvaSearch for more papers by this authorC. Amorim, C. AmorimSearch for more papers by this authorM. Dellu, M. DelluSearch for more papers by this authorA. Schmitt, A. SchmittSearch for more papers by this authorR. Soares, R. SoaresSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)62130-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S596-S596 RelatedInformation

ORIGINAL RESEARCH—PAIN: A Prospective Study of Pelvic Floor Physical Therapy: Pain and Psychosexual Outcomes in Provoked Vestibulodynia

Research suggests that increased tension in the pelvic floor muscles of women with provoked vestibulodynia (PVD, the most common form of chronic vulvar pain) may play an important role in maintaining and exacerbating their pain. However, no prospective studies of pelvic floor physical therapy (PFPT) for PVD have been carried out. This study prospectively examined the effectiveness of a PFPT intervention in treating the pain and sexual and psychological components of PVD, and determined predictors of greater treatment success. Thirteen women with PVD completed eight sessions of PFPT. Participants were assessed at pre- and post-treatment via gynecological examinations, vestibular pain threshold testing, structured interviews, and standardized questionnaires. A 3-month follow-up interview assessed any further changes. Outcome measures included: vestibular pain thresholds, gynecological examination and intercourse pain ratings, sexual function and intercourse frequency, mental health, negative pain cognitions, and success rates. Following treatment, participants had significantly higher vestibular pain thresholds and significantly lower pain ratings during the gynecological examination. Participants reported significant reductions in pain intensity during intercourse and were able to engage in significantly more pain-free activities. Although overall sexual function significantly improved, various components of sexual function and frequency of intercourse did not. Participants' mental health did not significantly improve; however, pain catastrophizing and pain-related anxiety significantly decreased. The treatment was considered to be successful for 10 of the 13 participants, and predictors of greater treatment success included greater reductions in helplessness and a longer period of time in treatment. Results provide preliminary support for the effectiveness of PFPT in treating the pain of PVD, as well as some of the sexual and cognitive correlates of PVD. The results also indicate the need for large-scale, randomized studies of the effectiveness of PFPT in comparison and in conjunction with other treatment options.

Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: A systematic review

Pelvic floor muscle training (PFMT) has Level A evidence to treat female urinary incontinence (UI). Recently, indirect training of the pelvic floor muscles (PFM) via the transversus abdominis muscle (TrA) has been suggested as a new method to treat UI. The aim of this article is to discuss whether there is evidence for a synergistic co-contraction between TrA and PFM in women with UI, whether TrA contraction is as effective, or more effective than PFMT in treating UI and whether there is evidence to recommend TrA training as an intervention strategy. A computerized search on PubMed, and hand searching in proceedings from the meetings of the World Confederation of Physical Therapy (1993-2007), International Continence Society and International Urogynecology Association (1990-2007) were performed. While a co-contraction of the TrA normally occurs with PFM contraction, there is evidence that a co-contraction of the PFM with TrA contraction can be lost or altered in women with UI. No randomized controlled trials (RCTs) were found comparing TrA training with untreated controls or sham. Two RCTs have shown no additional effect of adding TrA training to PFMT in the treatment of UI. To date there is insufficient evidence for the use of TrA training instead of or in addition to PFMT for women with UI. Neurourol. Urodyn. 28:368-373, 2009. (c) 2009 Wiley-Liss, Inc.

Muscle strength measurement of pelvic floor in women by vaginal dynamometer

The pelvic floor is made of a mutually connected system that consists of muscles, connecting tissue and nerve components. Damage to any of these elements creates dysfunction which is exerted through stress, urinary incontinence, prolapse of genital organs and faecal incontinence. The primary aim of this study was to present the possibility of objective assessment of pelvic floor muscle force in healthy and sick women using a newly designed instrument, the vaginal dynamometer, as well as to establish the correlation between the values of pelvic floor muscle force obtained by the vaginal dynamometer and digital palpation method. The study included 90 female patients, age 20-58 years. One group of respondents was made of healthy women (who gave birth, and those who have not given birth), while the other one consisted of sick women (who suffered from incontinence or prolapse of genital organs, operated on or not). The pelvic floor muscle strength of every woman was measured with a newly-constructed device for measuring and monitoring of the pelvic floor muscle force in women, the vaginal dynamometer. Then it was compared with the valid clinical digital palpation (palpation with two fingers) based on the scale for measuring muscle contractions with the digital palpation - the digital pelvic assessment rating scale. The vaginal dynamometer consists of a redesigned speculum which is inserted into the vagina and a sensor for measuring the force. Statistically significant linear correlation was found in the values of the measured muscle force with the vaginal dynamometer and ratings produced by digital palpation (r = 0.92; p < 0.001). Mean value of the muscle force of the healthy women measured by the vaginal dynamometer was 1.44 +/- 0.38 daN and that value of the sick women was 0.78 +/- 0.31 daN (t = 8.89 for df = 88; p < 0.001). Mean value of the ratings produced by digital palpation in healthy women was 4.10 (95% of trust limits 3.83-4.37), while the value in sick women was 2.41 (95% of trust limits 2.10-4.16) (Z = -6.38; p < 0.001). The vaginal dynamometer has been presented as an attempt to overcome the limitations of the previously presented techniques for muscle force measurement. The application of the vaginal dynamometer in clinical practice makes objective and numerical assessment of pelvic floor muscle force possible, independent of the subjective assessment of the examiner. The usage of this instrument enables not only the diagnostics of women's pelvic floor muscle problem, but also the objective monitoring of rehabilitation gynaecological medicine results.

Reproducibility of ultrasonic measurements of pelvic floor structures in women suffering from urinary incontinence

The aim of this study was to examine the reproducibility of ultrasound (US) findings relating to pelvic floor muscle in women with urinary incontinence (UI). Eighteen women with UI were examined twice by the same examiners over an interval of 1 month. The US findings comprised of (1) distance between bladder neck and symphysis pubis (BN/SP) at rest, during contraction, and while performing the Valsalva maneuver and (2) distance between anorectal angle and symphysis pubis (AR-SP) during the same conditions. Statistical analysis included test-retest correlations (ICC(3,K)), and the assessment of measurement error and smallest real difference (SRD) for change. BN-SP and AR-SP exhibited high ICCs. The lowest SRD values related to the AR-SP variables (10-19%). US-based measures of the bladder neck and the anorectal angle, distance, and displacement seem to offer reasonable clinical reproducibility.

Pregnancy Following Botulinum Toxin Type A Injections to the Levator Muscles for Chronic Pelvic Pain and Pelvic Floor Spasm

Study Objective: To report the outcome of pregnancies occurring within six months of injection of 80 to 100IU of Botulinum Toxin Type A (BOTOX®) into pelvic floor muscles in women suffering from chronic pelvic pain and associated pelvic floor muscle spasm.

Surface electromyography of pelvic floor muscles in stress urinary incontinence

Stress urinary incontinence (SUI), whose incidence has been reported to range between 15% and 60% among women [1,2], is defined as the involuntary passing of urine when abdominal pressure is increased. It is considered to result from a weakness of the pelvic floor, and some studies have shown evidence of partial denervation of the pelvic floor muscles in women with SUI [3]. However, there are few precise measurements of pelvic floor muscle activity. Electromyography is a noninvasive and welltolerated method of studying electric potentials produced by the depolarization of muscle fibers. The objective of this study was to obtain perineal electrophysiologic data and assess the clinical

28: Botulinum Toxin Type A (Botox) in the Treatment of Women with Chronic Pelvic Pain and Associated Spasm of the Pelvic Floor Muscles (PFM)

1. To report on the effect of Botox injected into the PFM of women with objectively demonstrable spasm. 2. To report outcomes to continued treatment for responders including pain scores, quality of life outcomes and re-injection intervals over a three-year period. 3. To present the results of an RCT.

Poster 2: Spontaneous Grade III Pelvic Organ Prolapse (POP) in the Rhesus Macaque

OBJECTIVE: We aim to compare the anatomic changes of POP in the rhesus with the clinical condition in women. METHODS: Marked uterovaginal prolapse was identified in a 13.9-year-old (human equivalent age 42) female rhesus macaque 8 months after her fourth vaginal delivery. Uterovaginal position was measured by -POPQ.” T1-weighted and fat-suppressed TSE T2-weighted magnetic resonance images (MRI) were obtained with the pelvis centered in an extremity coil (3 Tesla Siemens Magneton Trio). Perineal descent of the anal verge was measured perpendicularly to a line constructed from the inferior borders of the symphysis and the sacrum. Electromyographic activity (EMG) was evaluated in the anal sphincter, the pubovisceral and pubocaudalis muscles by concentric needle EMG. Muscles were identified during surgical dissection of the ischiorectal fossa with ketamine and opiate anesthesia. Nerve conduction studies were performed on the distal pudendal nerve through the perineal dissection, and on the proximal pudendal nerves and levator ani nerves through an abdominal dissection. The animal was euthanized and immediately perfused with 4% paraformaldehyde to preserve anatomic relationships within the pelvis. RESULTS: Gh is increased, pb is decreased, and perineal descent is increased with prolapse (Table 1). Passive flexion of the tail narrows and extension opens the genital hiatus. The spontaneous firing rates of the motor units were diminished, but motor unit action potentials obtained from the external anal sphincter (EAS) were with large amplitudes and multiphasic, consistent with reinnervation. Direct stimulation of the pudendal nerve proximally and distally elicited a visual twitch and corresponding muscle action potential in the right EAS, but no response could be elicited in the EAS with supramaximal stimulation to the left pudendal nerve. Direct stimulation of the levator ani nerves elicited both a visible twitch and a muscle action potential in the pubocaudalis (PC) and iliocaudalis. At surgical dissection, the uterosacral/cardinal ligament complex, the paravaginal attachment, and the aponeurotic origin of the PC were elongated, but there were no visible tissue breaks.TABLE 1CONCLUSION: This spontaneous case of POP in the rhesus mimics the human condition—with elongation of the genital hiatus, increased perineal descent, connective tissue elongation but not disruption, and evidence of nerve injury. Flexion and extension of the tail closes and opens the genital hiatus similar to contraction and relaxation of the pelvic floor muscles in women.

Histochemical and stereological analysis of the levator ani (pubocaudal) muscle in nulliparous and multiparous beagles

Fiber-type composition and several stereological parameters of the levator ani (pubocaudal) muscle were evaluated in five nulliparous and five multiparous beagles using myosin ATPase-histochemistry and systematically selected muscle cross-sections. With respect to the narrow canine pelvic cavity, this study was also undertaken to determine whether vaginal birth of at least seven litters causes similar neuromuscular changes in the canine levator ani (pubocaudal) muscle analoguous to those seen in the pelvic floor muscles of women after vaginal delivery. The canine pubocaudal muscle is comprised of approximately equal amounts of slow twitch type I and fast twitch type II (IIA, IIS) fibers. The muscles of both the nulliparous and multiparous beagles did not display any signs indicative of denervation or myopathology. The multiparous dogs exhibited significantly increased mean absolute muscle (1720 mm 3) and total fiber-type I volumes (850 mm 3) as well as relevantly increased mean diameter of type I fibers (72.0 μm) when compared with the nulliparous group. The canine levator ani (pubocaudal) muscle is not pathologically affected by vaginal deliveries and seems to adapt to numerous successive pregnancies and births through fiber-type I hypertrophy.

Surface electromyography diagnostics in women with partial vaginismus with or without vulvar vestibulitis and in asymptomatic women

The aim of this study was to investigate to what extent women with superficial dyspareunia can be diagnosed for both partial vaginismus (PaV) and vulvar vestibulitis (VVS) and to discover to what extent surface electromyography (sEMG) of the pelvic floor muscles (PFM) can distinguish between women with PaV solely, PaV + VVS, and asymptomatic women. A total of 224 consecutive women with superficial dyspareunia were examined clinically for both PaV and VVS diagnoses. We examined 47 women with PaV ± VVS and 27 asymptomatic women with sEMG of the PFM. The results showed that 102/224 women with superficial dyspareunia and 33/47 women with PaV in the sEMG part of the study had both PaV and VVS. All women with VVS had vaginismus, while 42/224 had PaV but not VVS. sEMG measurements revealed no significant differences between the three groups of women (PaV solely, PaV + VVS, and asymptomatic). Almost half of the women with superficial dyspareunia referred to our clinic have both the diagnosis PaV and VVS. sEMG was not a method of any value to distinguish between women with PaV solely, PaV + VVS, or asymptomatic women. The increased tone found clinically in the PFM of women with PaV ± VVS may be of other origin than electrogenic contractions.

Incontinence during pregnancy. Prevalence and opportunities for continence promotion.

A cross-sectional study using a structure interview was conducted with 304 women in the postnatal ward of a large NSW teaching hospital. Women were asked about any incontinence experienced in the last month of pregnancy, and about advice and interventions for bladder control or incontinence they had received during pregnancy. Sixty four per cent of women reported incontinence during pregnancy. Compared to women with no prior deliveries, those with a previous forceps delivery were 10 times more likely to experience incontinence, and with prior vaginal deliveries 4 times more likely to experience incontinence. Women who reported experiencing bouts of coughing on a regular basis during pregnancy were 4 times more likely to experience incontinence than those who did not. While 68% of the women reported being examined vaginally at least once during pregnancy, only 6% of the sample reported having their pelvic floor muscles tested during routine vaginal examination. Twenty three per cent of women reported having spoken with a healthcare professional regarding loss of bladder control. The results indicate that opportunities for continence promotion are not being utilized.

Neurophysiological findings in women with recurrent urinary incontinence after Burch colposuspension

The aim of this prospective observational study was to analyze the occurrence of neurogenic damage in the pelvic floor muscles in women with recurrent stress urinary incontinence, and to analyze whether a peripheral neuropathy in general covariates with possible neurogenic damage to the pelvic floor muscles. Seventeen women with recurrent stress urinary incontinence and 16 healthy continent women underwent a concentric needle electromyography (EMG) of the pubococcygeal muscles bilaterally and the external anal sphincter muscle, and a neurography of eight peripheral nerves. Seventy-five per cent of the healthy continent women displayed a deviant neurogenic pattern of the EMG in at least one of the pubococcygeal muscles, compared to 76% of the women with recurrent incontinence. Neurogenic patterns in all three investigated muscles were found significantly more often among the women with recurrent incontinence than in the healthy continent women. The age of all the women with neurogenic EMG patterns in all three muscles investigated was significantly higher than that of the women with neurogenic EMG patterns in two or less of the investigated muscles. The neurographic measurements showed no statistically significant differences between the groups. Conclusions showed that a neurogenic EMG pattern was frequently observed in the pubococcygeal muscles. Women with recurrent stress urinary incontinence were found to exhibit deviant EMG patterns in more pelvic floor muscles than did continent women.