Contraction Of Perineal Muscles Research Articles

Uroflow stop test with electromyography: a novel index of urinary continence recovery after RARP.

Urinary incontinence (UI) is one of the most bothersome surgical side effects after robot-assisted radical prostatectomy (RARP). Alteration of both smooth and striate urethral sphincter occurs after RARP. Since the contraction of perineal muscles is involved in the complex mechanism of urinary continence, the uroflow stop test (UST) seems to predict early continence recovery after RARP. The UST was added of perineal surface electromyography (EMG) evaluation to evaluate the latency time (LT) between muscular contraction and the complete stop of urine flow. Our aim was to present UST-EMG as a new tool in the investigation of UI, implying pelvic floor integrity, and to evaluate whether an early return (≤ 3 months) to preoperative LT could be associated with early recovery of UC (≤ 3 months). After prospectively enrolling 137 patients who underwent RARP with a minimum follow-up of 6 months, we identified two groups: Group 1 (93 patients) with early (≤ 3 months) pre-surgical LT recovery and Group 2 (44 patients) with late > 3 months or not able to reach pre-surgical LT recovery. Between the two groups, there were significant differences in terms of different surgical technique (nerve-sparing versus non-nerve-sparing) and pads use at 3 and 6 months after RARP (p < 0.05). No differences were recorded neither in postoperative maximum flow-rate, nor in postoperative symptoms score. UST with EMG can be considered as a noninvasive, reproducible and easily performable tool. LT is applicable in the clinical evaluation to predict urinary continence recovery after RARP.

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.

Actualización de la fisiología de la eyaculación. Definición, prevalencia y etiología de la eyaculación precoz

Ejaculation consists of two synchronized phases: a) emission, the contraction of the vas deferens, prostate and seminal vesicles and bladder neck expelling the seminal fluid to the urethra; it is mediated by sympathetic nerves, and b) expulsion, seminal fluid outward propulsion by the rhythmic contraction of perineal muscles. Ejaculation results from a complex spinal reflex having its essential components within the lumbosacral cord. The main afferent signals derive from mechanical stimulation of the glans penis and are conveyed by sacral sensory roots. The ejaculatory reflex is under strong modulatory influence from the brain through both facilitatory and inhibitory descending signals. Several central neurotransmitters including serotonin and dopamine modulate the ejaculatory reflex. The intravaginal ejaculatory latency time (IELT), measured or estimated, provides clinically useful assessment of the ejaculatory reflex. The new DSM-5 definition of premature ejaculation (PE) includes a specified time to ejaculation criterion (IELT of about one minute or shorter). Four subtypes of PE, showing different prevalence rates, have been proposed. PE etiology is multifactorial with interacting psychological and biological factors contributing to the disorder. A number of genetic polymorphisms related to serotonin and dopamine neurotransmission may predispose the bearers to developing PE. High prevalence rates of PE have been found in patients with chronic prostatitis, hyperthyroidism, and premature ejaculation.

Modeling the Anatomy and Function of the Pelvic Diaphragm and Perineal Body Using a “String Model”

Understanding the attachment and function of the pelvic diaphragm and perineal body is important for gynecologists, gastroenterologists, surgeons, and other medical practitioners. The structure and function of the pelvic diaphragm are typically introduced to medical students in anatomy class during

Influência dos exercícios perineais e dos cones vaginais, associados à correção postural, no tratamento da incontinência urinária feminina

OBJECTIVE: To investigate the influence of perineal exercises and vaginal cones in association with corrective postural exercises for static normalization of the pelvis, on female urinary incontinence treatment. METHOD: Twelve women with urinary incontinence complaints (mean age: 52.3 ± 9.7) were assessed via 10 physical therapy sessions, twice a week. They were divided into two groups: Group A (n = 6) underwent perineal exercises, while Group B (n = 6) used vaginal cones. Both groups performed postural exercises for static correction of the pelvis, in accordance with each patient's abnormalities. The following data were collected before and after the intervention: degree of perineal muscle contraction, via functional evaluation of the pelvic floor (FEPF); quantitative urinary loss, using the pad test; and sensations of dampness and discomfort, via a visual analog scale (VAS). Postural data were collected using the static pelvic test, muscle chain flexibility test and postural evaluation. RESULTS: Comparing the data before and after the intervention, there were statistically significant decreases in urinary loss (p < 0.05) for both groups. There were gains in pelvic floor muscle contraction and significant decreases in the sensation of dampness. The degree of discomfort following the intervention was significantly lower for the group that did perineal exercises. The pelvic static balance was corrected in most of the volunteers and there were gains in muscle chain flexibility. CONCLUSIONS: Static correction of the pelvis by means of postural exercises is an efficient method for female urinary incontinence treatment when associated with perineal muscle training.

COUGH ANAL REFLEX: STRICT RELATIONSHIP BETWEEN INTRAVESICAL PRESSURE AND PELVIC FLOOR MUSCLE ELECTROMYOGRAPHIC ACTIVITY DURING COUGH. URODYNAMIC AND ELECTROPHYSIOLOGICAL STUDY

Cough and more generally abdominal strain determine a pelvic floor contraction which allows an increase in sphincter pressure to prevent leakage during stress. Many electrophysiological studies have demonstrated this reflex (formally cough anal reflex). We postulated that the perineal muscle contraction following cough is not a simple binary response but proportional to the intensity of the cough. A total of 16 women (mean age 52 years) without neurological disease or stress urinary incontinence, referred for frequency and urgency without urge incontinence, underwent urodynamic investigation. Vesical pressure was compared to electromyographic activity of the anal sphincter during 4 successive coughs of different intensity, namely gentle, moderate, strong and very strong efforts. These 4 graded coughs were repeated at 0, 100, 200, 300 and 400 ml of filling during cystometry. All patients were able to determine a graded cough at each level of filling. In all patients and at each level of filling a strict relationship between intravesical pressure (intensity of cough) and integrated electromyographic value was demonstrated. The greater the intensity of the cough the greater the electromyographic response of the anal sphincter. There is a strict correlation between vesical pressure and integrated electromyographic value at rest at O (R2 = 0.983) or at 100 ml (R2 = 0.970), 200 (R2 = 0.918) or 300 ml (R2 = 0.960). Bladder filling does not modify the responses. Pelvic floor muscle contraction increases with the importance of intra-abdominal pressure generated during stress. This gradual adaptation of pelvic floor muscles is probably 1 of the main factors which contributes to stress urinary and fecal continence in women. It must be preprogrammed by the central nervous system to maintain continence during various stresses.

Effect of straining on perineal muscles and their role in perineal support: identification of the straining-perineal reflex

Objectives. The functional activity of the superficial (STPM) and deep (DTPM) transverse perineal muscles is poorly addressed in the literature. We investigated the hypothesis that these muscles act to support the perineum during increased intraabdominal pressure (IAP). Methods. 46 healthy volunteers (mean age 30.4 ± 1.2 y, 20 nulliparous women) were studied. The IAP was recorded by a manometric catheter introduced into the rectum. The response of the perineal muscles to straining (sudden by coughing and slow by Valsalva’s maneuver) was registered by a needle electrode inserted into the STPM and DTPM separately. The response was recorded again after individual anesthetization of the perineal muscles and rectum using Xylocaine. The test was repeated using saline instead of Xylocaine and was performed on both sides. Results. Straining (sudden or slow sustained) effected increase of the rectal pressure and the motor unit action potentials of both perineal muscles. The higher rectal pressure was increased by straining, the higher the motor unit action potentials increased MUAPs. The latency showed a gradual decrease upon incremental rectal pressure elevation. The perineal muscles did not respond to straining after individual anesthetization of the rectum and perineal muscles, but did respond to saline administration. The response was similar from muscles on both sides. Conclusion. Perineal muscle contraction on straining postulates a reflex relationship that we call the “straining-perineal reflex.” We suggest that this reflex, which results in perineal muscle contraction, supports the perineum against the increased IAP induced by straining and the tendency of the perineum to descend. The results warrant further study of the role of the straining-perineal reflex in the genesis of perineal functional disorders.

産婦人科領域における会陰筋の筋電図的研究

With the purpose to investigate the functional changes of the perineal muscles brought about by pregnancy and delivery, the author determined the _??_-S relationship in the electromyograph of the bulbo-cavernous muscle and levator ani muscle in women married but not pregnant, multipara, multigravida (but without normal delivery), and in women with uterovaginal prolapse at the time when the perineal muscles had been variously made to contract intensely either at rest or intentionally all the while maintaining such a contraction in each case as constantly as possible, and studied the _??_-S relationship. The following are the results:1. In the perineal muscles like in other skeletal muscles there are two kinds of the functional differentiation in NMU, namely, kinetic NMU and tonic NMU.2. The ratio of the discharge groups between tonic NMU and kinetic NMU in the bulbocavernous muscles and levator ani muscles in any of the four goups of women mentioned above lies between 1.86 and 2.00 in the case of bulbo-cavernous muscles while between 2.14 and 2.22 in the levator ani muscles, showing no marked changes in either case.3. In the _??_-S relatinnship of the bulbo-cavernous muscles and levator ani muscles both K and T curves tend to show a shift to right in the bulbo-cavernous muscles; and therefore, the levator ani muscles seem to be the muscle more adapted for mainataining a sustained movement than the bulbo-cavernous muscles.4. That both K and T curves, especially the T curve, tend to show the shift to right in pregnancy seems to indicate that the contracting mechanism of the perineal muscles is functioning smoothly in unison with abdominal distention, the perineal muscles playing a role of barotaxic muscle.5. In the cases with uterovaginal prolapas T curve in both the bulbo-cavernous and levator ani muscles tends to show a shift to left, and in addition, S is increased in both K and T curves. This phenomenon is due to the shortened range of smoothly-working adjustment mechanism at the intentional contraction of muscles with consequent diminution in barotaxic action.As for the intensity of the muscular contraction, it is determined by the amplitude of the discharge of an individual NMU, and it is also determined by numbers of NMU acting at the same time. Therefore, there is as yet no conclusive evidence proving any clear-cut quantitative relationship between the frequency of spike discharge appearing in mucslce fibers and the intensity of the muscle contraction.However, the author has been able to clarify that the intensity of the muscle contraction, as determined even by such a simple method as to determine numbers of discharge at a given unit of time with the use of a concentric type of elctrodes, coincides with clinical findings and that the determination of the degree of perineal muscle contraction and the observation on the action of hormoues (especially progesterone) on the perineal muscle are clinically valuble. Namely:1. In pregnancy the frequency of discharge in the perineal muscles is decreesed, and it is still further decreased with advance in the pregnant month. The abortion, however, brings this lowered frequency gradually back to the normal level.2. Even in the cases of uterovaginal prolapse, the frequency of discharge is diminished, and such a diminution is proportional to the degree of uterovaginal prolapse.3. Progesterone acts as to relax the perineal muscle while estradiol has no marked effect on the myogenic tonus of the muscles.4. In the case of functional hemorrhage, the tonus of the perineal muscles is either slightly or moderately accelerated.5. The tonus of the perineal muscles in uterine hypoplasia is also accelerated.6. It seems that there is no causal realtion between hormones and the perineal muscle tonus in uterine cancer, uterine myoma, and ovarian cystom.