Perineal Contraction Research Articles

Efeitos da estimulação transcraniana por corrente contínua e treinamento muscular do assoalho pélvico em mulheres: protocolo para um ensaio clínico controlado, randomizado e duplo-cego

ABSTRACT Pelvic floor muscle weakness can lead to urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Although it can be minimized by pelvic floor muscle training (PFMT), its effects are not lasting. Therefore, using combination therapy seems promising. This study aims to evaluate the effect of transcranial direct current stimulation (tDCS) combined with PFMT on intravaginal pressure, pelvic floor muscle strength (PFMS), sexual function (SF), and quality of life (QoL) in healthy women. A total of 32 women, aged from 18 to 45 years, will undergo PFMT (with perineal contractions and relaxation) with the aid of pressure biofeedback associated with active tDCS or sham tDCS. Sessions will last 20 minutes, three times per week, for four weeks, totaling 12 sessions. During the protocol, participants will be instructed to also perform the home-based PFMT daily. The tDCS anodal electrode will be positioned over the supplementary motor area of the dominant cortical hemisphere, whereas the cathodal will be over the contralateral supraorbital region, with a 2mA intensity for 20 minutes. Intravaginal pressure (pressure gauge), PFM strength (measured by digital palpation and the PERFECT scheme), FSFI (Female Sexual Function Index), and QoL (SF-36 questionnaire) will be evaluated before and after the 12 sessions and after a 30-day follow-up.

Correlation between nutritional status and perineal muscular strength in women with urinary uncontinence in the brazilian state of Roraima / Correlação entre o estado nutricional e a força muscular perineal nas mulheres com incontinência urinária no estado brasileiro de Roraima

Introduction: To evaluate the muscular strength of pelvic floor in women with complaints of voiding dysfunction and to associate it with their nutritional state. Specifically, the current work focuses on evaluating the force of contraction of the perineal muscles in women with voiding dysfunction and correlates the degree of muscular contraction of the pelvic floor through biofeedback and manual palpation. Material and Methods: This case-control study presents comparative laboratory tests of nutritional analyses and the degree of muscle contraction of the pelvic floor between the cases and the control groups. Urination disorders were evaluated through urodynamic study and King’s health questionnaires. Results: The force of contraction between normal and urinary incontinent females as measured by Ortiz’s scale was statistically insignificant. Perineal muscle function was negatively correlated with age and positively with perineal contraction while biofeedback was negatively correlated with knee height and globulin level and this difference was statistically significant. The biochemical tests for nutritional analysis were comparable between cases and control indicating no effect on urinary incontinence. Conclusions: The force of urinary contraction is independent of the state of urinary incontinent. With age, the strength of perineal muscle function goes down.

Transabdominal ultrasound to assess the displacement of the bladder base during abdominal and pelvic floor contractions in continent parous versus nulliparous women.

The effect of different abdominal contractions on the position of pelvic organs in parous women during postpartum exercises has not been sufficiently assessed. The aim of this study was to evaluate the displacement of the bladder base (BB) during different pelvic floor and abdominal contractions in parous women compared to nulliparous women. We hypothesised that abdominal and perineal contractions will produce a disparate effect on the position of the BB between groups. Cross-sectional study including a convenience sample of 63 volunteers (35 nulliparous vs. 28 postpartum women). Transabdominal ultrasound was used in mode B to image the displacement of the BB. The protocol included six different pelvic floor and abdominal contractions commonly used in postpartum rehabilitation. The BB elevated significantly more in the postpartum group compared to nulliparous women when performing submaximal contraction of pelvic floor and transversus abdominis muscles simultaneously with axial elongation of the back (0.93 ± 0.55cm in parous women vs. 0.66 ± 0.46cm in nulliparous women). In contrast, the BB was found to descend significantly during a curl-up contraction in both groups (0.93 ± 0.55cm in parous women vs. 0.66 ± 0.46cm in nulliparous women). The overall results of this study showed that perineal and superficial abdominal contractions produced different immediate effects compared to deep abdominal contractions on the displacement of BB in parous and nulliparous women. Further research is required to assess the long-term effects of these contractions.

The influence of Mat Pilates associated with perineal contraction in the female sexual response

Background: The Pilates Method is a program of physical and mental training that involves the whole body, aiming at the gain of muscular strength, mainly of the central region, formed by the abdominal muscles, the spine and the pelvic floor muscles (PFM). The PFM responds to sexual stimulation, with increased local blood circulation and involuntary contractions during orgasm. The training of this musculature assists in the female sexual function. Objective: To evaluate the influence of Pilates Mat associated with perineal contraction in the female sexual response. Method: Uncontrolled clinical trial in which participated twelve women between 20 and 50 years old, who performed Mat Pilates classes associated with perineal exercises, three times a week. The sexual response was evaluated through the Female Sexual Function Index (FSFI) and the contraction capacity of PFM through the Functional Evaluation of the Pelvic Floor (FEPF) before and after 21 sessions. Results: Given the proposed treatment, the FSFI responded positively (0.0099), with an improvement in the median and interquartile range that initially was 25.6 ± 5.4 and increased to 28.4 ± 1.2. The Functional Evaluation of the Pelvic Floor (FEPF) also achieved significant improvement (p= 0.0077), increased from the initial median and interquartile range of 2 ± 1.5 to 4 ± 1. Conclusion: Mat Pilates provides encouraging results, and its use is relevant to promote improved sexual response and strength gain of the pelvic floor muscle.

Development of an anatomic intravaginal device and comparison with a conventional vaginal cone regarding their effectiveness in pelvic floor muscle perception and strength: randomized clinical test

The weakness and lack of perception of the perineal musculature and pelvic floor cause a series of emotional and social problems that can affect the social quality of life. This muscular structure is responsible for maintaining the support of the internal organs and participating in the maintenance of the urinary and fecal continence, as well as allowing coitus and childbirth. The objective of this study was evaluating the maximum pressure during the contraction of the perineal musculature and the performance of the pelvic floor muscles after using both the anatomical intravaginal device and the conventional vaginal cone. For this purpose, 30 women were selected and randomly and equally divided into 3 groups: Group I, control; Group II, used the conventional vaginal cone; and Group III, used the anatomically shaped intravaginal device, developed in order to accomplish the research. The volunteers in Groups II and III were respectively submitted to a protocol with the vaginal cone and the intravaginal device, and, after the use, they were assessed in order to verify their maximum pressure and the capacity of pelvic floor contraction. The analysis of the data showed a statistically significant difference, concerning the evaluated parameters, in the group that used the anatomically shaped intravaginal device. The anatomical intravaginal device, developed in this study, was more effective than the conventional vaginal cone regarding the improvement of the maximum perineal contraction pressure, local perception, and muscular performance.

Parameters of 2-Dimensional Perineal Ultrasonography Before and After Male Sling Procedure for Urinary Incontinence After Radical Prostatectomy

To compare ultrasonographic patterns of 2-dimensional perineal ultrasonography in men in the preoperative and postoperative periods after transobturator sling deployment for the treatment of urinary incontinence after radical prostatectomy. Radiotherapy and radical prostatectomy are the primary treatments for localized prostate cancer. Studies comparing anatomic changes in men before and after radical prostatectomy based on perineal ultrasonography are scarce in the literature. Thirty-one patients from 2 centers were selected for examination and surgery. They were allocated into mild and/or moderate and severe incontinence groups who underwent the transobturator sling procedure between August 2014 and August 2018. Perineal ultrasonography was performed in the preoperative period for 21 of these patients and 3-6 months postoperatively after the transobturator sling procedure for 30 patients. Hypermobility of the proximal urethra and voluntary contraction of the pelvic floor were evaluated during the Valsalva maneuver, perineal contraction and at rest. Clinical improvements of >50% were significantly more frequent in the mild and/or moderate vs severe incontinence group after male sling surgery (P = .035). Patients who demonstrated clinical improvement >50% showed a significantly greater displacement of the posterior portion of the bladder neck during contraction than those with clinical improvement <50% (P = .024). The most important finding of this study was the significant difference in the posterior displacement of the bladder neck during contraction in patients who showed an improvement >50% compared with those with an improvement <50%. These data support the use of perineal ultrasonography in evaluating and selecting patients for the male sling procedure.

A Controlled Clinical Trial on the Effects of Exercise on Lower Urinary Tract Symptoms in Women With Multiple Sclerosis.

The aim of the study was to investigate the effects of two pelvic floor exercise programs on lower urinary tract symptoms and quality of life in participants with multiple sclerosis. This is a prospective, single-blind, clinical trial. The study used a community rehabilitation program within a large metropolitan health service. Thirty women in moderate stage of multiple sclerosis were referred for outpatient rehabilitation. In a period of 6 mos, participants underwent a pelvic floor exercise program, associated or not with vaginal electrotherapy. The main outcomes are overactive bladder, perineal contraction, and quality of life. The findings showed benefits of both programs on overactive bladder and quality of life. Participants undergoing exercise plus electrotherapy presented greater improvement on contraction of the perineal musculature and quality of life. Six months of exercise provided benefits on lower urinary tract symptoms and quality of life in women with multiple sclerosis. Electrical stimulation potentiated the improvement on perineal musculature and quality of life. This trial was registered prospectively with the Clinical Trials Register, ID: BR-287q65 (http://www.ensaiosclinicos.gov.br/rg/RBR-287q65/).

Confiabilidade e concordância intra e interavaliadores na avaliação da pressão perineal em nulíparas

AIMS: To verify intra and inter-rater reliability and concordance in the assessment of perineal pressure in nulliparous women.METHODS: Young, healthy, nulliparous, non-pregnant women who had had sexual intercourse and had a correct contraction of the perineal musculature on physical examination were included. Women were excluded if they used other muscles in a visually perceptible way during the perineal contraction; with changes in the pelvic muscles tone; with urinary incontinence; with cognitive alterations; with disease that could affect the muscular and nervous tissues; or practitioners of high-impact physical activity. The participants were submitted to two assessments of perineal pressure on the same day, with different evaluators. After one week the protocol was repeated. Perineal pressure was determined by means of a perineometer and obtained by the difference between the maximum pressure (Pmax) and the minimum pressure (Pmin) recorded by the device, in millimeters of mercury. Sustained contraction (SC) was evaluated by the time in seconds. In order to determine reliability, the intraclass correlation coefficient (ICC) was used. Bland-Altman test was used for the concordance analysis. Comparison of means was performed by the Wilcoxon test. A value of p≤0.05 was considered significant.RESULTS: Ten participants were included, with a mean age of 23.8±2.9 years and a body mass index of 22.2±1.8 kg / m². The evaluator A obtained excellent intra-rater reliability for Pmin (ICC=0.86, p&lt;0.01) and Pmax (ICC=0.92, p&lt;0.01); very good reliability for perineal pressure (ICC=0.65, p=0.01); and no statistical significance for SC. For evaluator B, there was no statistical significance for Pmin and Pmax, but there was very good reliability for perineal pressure (ICC=0.78, p&lt;0.01) and SC (ICC = 0.70, p&lt;0.01). In the inter-rater analysis (A vs B), on day 1 there was no statistical significance for Pmin, Pmax and perineal pressure; but there was very good reliability for SC (ICC=0.71, p&lt;0.01). On day 2, there was no statistical significance for Pmin and Pmax, but there was very good reliability for perineal pressure (ICC=0.62, p=0.02) and good for SC (ICC=0.56, p=0.03). There was agreement between intra and inter-rater measurements.CONCLUSIONS: Perineal pressure measurements showed very good intra-rater reliability and good to very good inter-rater reliability, with intra and inter-rater concordance.

Effect of osteopathic correction on strengthening of the perineal muscles in the postpartum rehabilitation period

Introduction. The effect of the osteopathic treatment in the postpartum period has not been adequately studied in Western countries. The most part of the studies are focused on postpartum pain, whereas there is not enough information on the effect of osteopathic treatment on the recovery of perineal muscles.Goal of research - to study the effect of osteopathic treatment in combination with physical therapy on the recovery of the perineal muscle system in women in the postpartum period. Materials and methods. The study examined 38 women (mean age 30±5 years old) who underwent therapy in order to restore the perineal muscular system in the postpartum period. They were divided into two groups. Patients of the focus group received therapy in combination with the osteopathic correction. Women of the second group received therapy in combination with the imitation of manual treatment. Results. The data analysis shows a signifi cant difference in the results of testing of the perineal muscle strength in patients of both groups by the end of the treatment: from 24,51±18,55 to 148,21±127,51 in the focus group, and from 29,32±20,32 to 94,22±78,51 in the control group. The intensity and the duration of the perineal muscle contraction did not differ signifi cantly by the end of the treatment in both groups.Conclusion. Osteopathic treatment in combination with the rehabilitation therapy of the perineum signifi cantly improves the muscle tone and promotes the restitution of the perineal muscle quality in the postpartum period in comparison with classical treatment.

Démonstration neurophysiologique d’un réflexe périnéo-vésico-sensitif inhibiteur

Need to void level depends on two parameters, bladder volume and attentional process. If it is well known that the maximum voluntary contraction of the perineal muscles may transiently inhibit the micturition reflex itself, no work demonstrates the effect of this contraction on the intensity of the need itself. An experimental, prospective, open, monocentric study was conducted between March and April 2017. In total, 15 subjects with no neurological history or neuro-perineal disorders consulting for functional constipation were included. Need to void level was evaluated by means of an electronic urgentometer. A control contraction of the dominant hand muscles was compared to a voluntary contraction of the external anal sphincter during a strong desire to void (B3). These contractions were recorded by means of surface electromyography. The main evaluation criterion was the comparison between the difference in visual analogic scale of the desire to void before (VAS-base) and after control voluntary contraction (VAS-hand) versus the same index (BAS-base then VAS-anal) after contraction of the external anal sphincter during a new B3. The comparison of maximum bladder capacities (MBC) measured after each record was the secondary endpoint. Wilcoxon signed rank test was used for statistical analysis. Voiding desire VAS decreased significantly (-13.14±12 vs -1.5±6; P=0.03) and MBC increased significantly (502.43±96.71mL vs 435.78±125.54mL; P=0.02) after anal compared to control contraction. This study suggests the existence of sensitive pathways inhibition by perineal contraction through a sensitive perineo-vesical inhibitory reflex. 3.

Correlation Between Sexual Function and Strength of the Pelvic Floor Muscles in Women With Dyspareunia [6G

INTRODUCTION: Dyspareunia is defined as persistent or recurrent genital pain that occurs just prior to, during or after sexual intercourse, causing intense suffering or interpersonal conflict. Evaluating sexual function and strength of the pelvic floor muscles represents an important element when assessing dysfunctions such as dyspareunia. METHODS: A cross-sectional study involving 50 sexually active women of 18-35 years of age, 25 with dyspareunia and 25 without dyspareunia. Questionnaires were used to obtain the eligible women’s biological, sociodemographic and urogynecological characteristics. The Female Sexual Function Index was used to evaluate sexual function. Clinical evaluation of the pelvic floor was conducted to verify the presence of perineal contraction, with dynamometry being performed immediately afterwards. The Shapiro-Wilk and Mann-Whitney tests were used in the statistical analysis, together with Spearman’s rank correlation coefficient. Significance was established as 5%. RESULTS: Dynamometric measurements of superficial (p=0.01) and deep muscle strength (p=0.04) during pelvic floor muscle contraction were also lower in the dyspareunia group. A fair positive correlation (r=0.382; p=0.03) between the pain during sexual intercourse domain and dynamometric measurements of superficial muscle strength. CONCLUSION: A reduction was found in the dynamometric measurements of pelvic floor muscle strength in women with dyspareunia compared to those without dyspareunia and a correlation was found between pain and dynamometric measurements of superficial muscle strength.

Impact of a Pelvic Floor Training Program Among Women with Multiple Sclerosis: A Controlled Clinical Trial.

The objective of this study was to investigate the effects of two programs for strengthening the pelvic floor on the urinary incontinence of patients with multiple sclerosis (MS). This is a prospective study of the clinical trial type, monitored for 6 mos, in which 24 women in the moderate stage of MS participated in a program of exercises for strengthening the pelvic floor-associated (experimental group) or not (control group) with electrotherapy. The variables analyzed were as follows: quality-of-life, overactivity of the bladder, perineal contraction, and level of anxiety and depression. The statistical procedures involved multivariate analyses of repeated measurements, with a significance of 5%. Initial homogeneity being observed in the anthropometric and clinical variables, both protocols resulted in improvements in quality-of-life (P = 0.001), overactive bladder (P = 0.001), perineal contraction (P = 0.004), and level of anxiety (P = 0.001) and depression (P = 0.001), in relation to the initial comparison. The association of electrotherapy with strengthening exercises increased the improvement of the patients regarding overactive bladder (P = 0.039) and perineal contraction (P = 0.001), in comparison with the control group. The results reinforce the benefit of exercises for strengthening the musculature of the pelvic floor in women with overactive bladder in MS and demonstrate a potential of the action when associated with electrotherapy. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Identify common dysfunctions of the lower urinary tract in women with multiple sclerosis; (2) Discuss the relationship between quality-of-life, level of anxiety and depression, degree of perineal contraction, and overactive bladder; and (3) Recognize the benefits promoted by physical therapy for strengthening the pelvic floor in patients with multiple sclerosis. Advanced : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Influence of a distraction task on the involuntary reflex contraction of the pelvic floor muscles following cough.

To explore the involvement of a distraction task in involuntary reflex pelvic floor muscle contraction following cough. Informed consent was obtained from 33 healthy volunteers. Involuntary contraction of the external anal sphincter (EAS) was induced by means of coughing. Cough efforts were elicited by electronic order. The electromyographic (EMG) activity of the EAS was recorded during involuntary contraction elicited by coughing. The trials were carried out twice: combined (or not) with a mental distraction task; the paced auditory serial additional test (PASAT). Reaction time (RT) defined as latency between the stimulus and maximum EAS EMG activity (RT1), latency between the stimulus and external intercostal (EIC) muscle EMG activity (RT2), latency between EIC EMG activity and EAS EMG activity (RT3), duration of the contraction, and the area under the EAS EMG activity curve (perineal contraction) were measured. The distraction task altered anticipation of the PFM contraction: RT3 was -80.00 ms (IQR -107; -56) without the PASAT versus -56.67 ms (IQR: -94; -2) with the distraction task (ratio 0.71, P = 0.0045, Wilcoxon test). RT2 was altered during the distraction task: 583.33 ms (IQR: 344-775) without PASAT versus 652.71 ms (503-790) during PASAT (ratio 1.12, P = 0.031, Wilcoxon test). Finally, when the two conditions (respectively with and without the mental distraction task) were compared, there was a significant difference between the area under the EAS EMG activity curve (0.0115 mv sec vs. 0.0103 mv sec, ratio 0.90, P = 0.023). The mental distraction task altered involuntary reflex contraction of the pelvic floor muscles. Neurourol. Urodynam. 36:160-165, 2017. © 2015 Wiley Periodicals, Inc.

New device and new concept for treating nocturnal enuresis: Preliminary results of a phase one study

ObjectiveThis new device for nocturnal enuresis (NE) consists of a humidity sensor, which beyond activating the sound also triggers an electrical stimulus, contracts the pelvic floor muscles and closes the urethra, thereby interrupting the void. The aim of this study is to test if the theoretical principle described above is true and if the device used is safe. As a secondary endpoint, we studied the efficacy of this device in a small number of patients with NE. Material and methodsThe age of the patients ranged from 7 to 20 years old, with an average of 11 years. Two surface electrodes are placed at 3 and 9 o’clock on the perineum area. When the humidity sensor is activated it triggers an electrical circuit with a current frequency of 50 Hz. After 20 s of perineal contraction, if the patient does not turn down the device, a buzz sounds and the parents or the child will wake up. In this way, the child is taught to go to the toilet and void. All patients who used the device were also treated with behavior modifications. The definition of resolution of NE was 1 month of dry consecutive nights. ResultsAll patients had daily or almost daily NE (two failed with DDAVP and alarm treatment). Four patients had monosymptomatic NE and two had the non-monosymptomatic form. In five patients the device worked as expected and one patient continued wetting the bed and dropped out of the treatment. The five patients who kept using the device had the symptoms resolved completely. There were no recognizable side effects associated with this treatment. ConclusionThe presented device works as a conventional enuresis alarm with the addition of a pelvic floor contraction. This has the advantage of the children not wetting the bed during treatment. This principle was proved by this study and the device demonstrated itself to be safe.

Electrostimulation, response of the pelvic floor muscles, and urinary incontinence in elderly patients post prostatectomy

Objective to investigate the response of the pelvic floor muscles (PFM), and urinary incontinence (UI), in patients having undergone a prostatectomy, after treatment using electrical stimulation. Materials and methods this observational study was conducted in an outpatient urogynecologic physical therapy clinic of Hospital dos Servidores in Rio de Janeiro, Brazil from August to September 2012. Ten patients (aged, 64 ± 7 years) with urinary incontinence resulting from radical prostatectomy, having received surgery within six months of study entry, without urinary infection, and without metallic implants underwent electrical stimulation of the PFM, while in lateral decubitus position with knees and hips flexed. The parameters used were 65 Hz frequency, pulse width of 500 µs, biphasic current, intensity according to the tolerance level reported by the patient, perineal contraction time of four seconds, and rest time of eight seconds for 20 minutes twice a week, totaling 16 sessions of electrical stimulation with active-assisted contraction. Patients were evaluated before and after electrical stimulation through physical therapy evaluation of urinary incontinence, by being asked about the number of disposable guards used daily, using a visual analogue scale (VAS) to measure how the UI interfered with activities of daily living, and by electromyographic biofeedback to measure the work of the PFM. Data were analyzed using Student’s paired t-tests and a significance level of 0.05. Results after 16 sessions of electrical stimulation, the electromyographic biofeedback evaluation showed a significant increase in muscle strength of 10.73 ± 8.64 to 17.16 ± 9.00 µV (t = -3.39, P = 0.008), a significant decrease in the number of diapers used before and after treatment (3.9 ± 1.2 to 1.8 ± 1.5, respectively; t = 5.16, P = 0.0006), and a significant decrease in the interference of urinary incontinence on daily activities of 9.6 ± 0.5 to 4.0 ± 3.8 (t = 5.15, P = 0.0006). Conclusion electrical stimulation may represent a novel way to strengthen the pelvic floor muscles and decrease urinary incontinence resulting from radical prostatectomy.

Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis

An intradural somatic-to-autonomic anastomosis, or Xiao procedure, has been described to create a "skin-CNS-bladder" reflex that improves bladder and bowel function in patients with neurogenic bladder and bowel dysfunction. The authors present their experience with a 10-year-old boy with chronic neurogenic bladder and bowel dysfunction related to spinal cord injury who underwent the Xiao procedure. After undergoing a left L-5 ventral root to left S2-3 intradural anastomosis, the patient reported that his bladder and bowel dysfunction improved between 6 and 12 months. Two years after the procedure, however, he reported that there was no change in his bladder or bowel dysfunction as compared with his condition prior to the procedure. Frequent, systematic multidisciplinary evaluations produced conflicting data. Electrophysiological and histological evaluation of the previously performed anastomosis during surgical reexploration 3 years after the Xiao procedure revealed that the anastomosis was in anatomical continuity but neuroma formation had prevented reinnervation. Nerve action potentials were not demonstrable across the anastomosis, and stimulation of the nerve above and below the anastomosis created no bladder or perineal contractions. This is the first clinical report on the outcome of the Xiao procedure in a child with spinal cord injury outside of China. It is impossible to draw broad conclusions about the efficacy of the procedure based on a single patient with no demonstrable benefit. However, future studies should carefully interpret transient improvements in bladder function, urodynamic findings, and the patient's ability to void in response to scratching after the Xiao procedure. The authors' experience with the featured patient, in whom reinnervation could not be demonstrated, suggests that such changes could be related to factors other than the establishment of a skin-CNS-bladder reflex as a result of a somatic-to-autonomic anastomosis.

A comparative analisys of pelvic floor muscle strength in women with stress and urge urinary incontinence

To assess pelvic floor muscle (PFM) strength in women with stress urinary incontinence (SUI) and urge urinary incontinence (UUI). 51 women were prospectively divided into two groups, according to the symptoms as SUI (G1 = 22) or UUI (G2 = 29). Demographic data, such as number of pads/ 24 hours, number of micturations/ 24 hours and nocturia, delay time of urgent void (i.e., the time period for which an urgent void could be voluntarily postponed), number of parity and vaginal deliveries were obtained using a clinical questionnaire. Objective urine loss was evaluated by 60-min. Pad Test, subjective urine stream interruption test (UST) and visual survey of perineal contraction. Objective evaluations of PFM were performed in all patients (vaginal manometry). Median of age, mean number of pads / 24 hours, nocturia and warning time were significantly higher in UUI comparing to SUI group. During UST, 45.45% in G1 and 3.44%, in G2, were able to interrupt the urine stream (p < 0.001). The 60-min. Pad Test was significantly higher in G2 compared to G1 women (2.7 ± 2.4 vs 1.5 ± 1.9 respectively, p = 0.049). Objective evaluation of PFM strength was significantly higher in the SUI than in the UUI patients. No statistical difference was observed regarding other studied parameters. Pelvic floor muscle weakness was significantly higher in women with UUI when compared to SUI.

Effects of High-Velocity, Low-Amplitude Spinal Manipulation on Strength and the Basal Tonus of Female Pelvic Floor Muscles

Objective Spinal manipulation with high-velocity and low-amplitude (HVLA) manipulation is frequently used for the treatment of lumbopelvic pain; however, the effect on the pelvic floor has been poorly studied in the past. The objective of this study was to quantify the intravaginal pressure (IVP) and the basal perineal tonus (BPT), measured in terms of pressure, before and after the HVLA manipulation in patients without neuromuscular and skeletal dysfunctions. Methods In this experimental, noncontrolled, nonrandomized study, IVP was obtained through a perineometer introduced into the volunteers' vagina while in dorsal horizontal decubitus. Forty young, healthy university volunteer women with no history of vaginal delivery participated. All voluntary contractions of the perineal muscles were measured in 3 different ways: phasic perineal contraction (PPC), tonic perineal contraction, and perineal contraction associated to accessory muscles. New pressure measurements were obtained immediately after the HVLA manipulation on the volunteers' sacrum. The pressures were registered and transcribed directly to a personal computer with specific software. Results The average IVPs obtained in millimeters of mercury before and after the HVLA manipulation were 56.01 (±25.54) and 64.65 (±25.63) for PPC, 445.90 (±186.84) and 483.14 (±175.29) for tonic perineal contraction, and 65.62 (±26.56) and 69.37 (±25.26) for perineal contraction associated to accessory muscles, respectively. There was significant statistical variation only for PPC ( P = .0020) values. The BPT increased regardless of the type of contraction ( P < .05). Conclusion High-velocity and low-amplitude manipulation of the sacrum was associated with an increase of PPC and of BPT in women who had no associated osteoarticular diseases. These preliminary discoveries could be helpful in the future study of the treatment of women with perineal hypotony.

Pelvic floor muscle evaluation in incontinent patients

The aim of this study was to assess pelvic floor muscle (PFM) strength and perception and its correlation with stress urinary incontinence (SUI). One hundred and one women were divided into two groups according to the presence (G1=51 patients) or absence (G2=50 patients) of SUI. Subjective [urine stream interruption test (UST), visual survey of perineal contraction and transvaginal digital palpation to assess pelvic muscle contraction] and objective evaluations of pelvic floor muscles in all patients were performed (vaginal manometry). During the UST, 25.5% of G1 patients and 80% of G2 patients were able to interrupt the urine stream (p<0.05). Digital evaluation of pelvic muscular contraction showed higher strength in G2 than in G1 patients (p<0.0001). Perineometer evaluation of PFM strength was significantly higher in the continent group (p<0.001). Pelvic floor muscle weakness in incontinent patients demonstrates the importance of functional and objective evaluation of this group of muscles.

The after-contraction: a true detrusor contraction or a late dyssynergic urethral sphincter contraction?

To evaluate the mechanism and significance of the after-contraction, recorded in bladder pressure by urodynamics, at the end of micturition. The urodynamic recordings showing an after-contraction of the detrusor in 65 patients of all ages and with a variety of pathologies were re-examined. Special attention was directed to the anal or urethral sphincter needle electromyographic activity and to the monitored urethral pressure, to determine any relationships with the patterns of detrusor pressure. An after-contraction was noted in 61 patients with detrusor instability and in 11 with urethral instability. In 59 patients it was evident that the after-contraction, i.e. a renewed increase in detrusor pressure during the declining contraction, correlated with a sphincter contraction preceding it by a fraction of a second. Similar increases in detrusor pressure were apparent in patients with detrusor-sphincter dyssynergia throughout voiding. In six patients the relationship was less clear mainly because there were artefacts in the curves. The after-contraction arises by a sudden stopping of the outflow of urine, provoked by a sphincter contraction. This may occur by involuntary dyssynergia or by an early voluntary interruption of the voiding stream. The 'milk back' of urine from the proximal urethra to the bladder and the inhibited detrusor contraction (if the perineal contraction is prolonged) may cause some postvoid residual urine. It occurs mainly in the presence of detrusor and/or urethral instability.