Reflex Pelvic Floor Research Articles

Effect of posture on the reflex and voluntary pelvic floor muscle contraction during distraction task

Effect of posture on the reflex and voluntary pelvic floor muscle contraction during distraction task

Effect of body position on reflex and voluntary pelvic floor muscle contraction during a distraction task.

To explore the impact of body position (sitting vs standing) on voluntary and reflex pelvic floor muscle (PFM) contraction during a mental distraction task (DT). Informed consent was obtained from 19 healthy women. The electromyographic (EMG) activity of the external anal sphincter (EAS) was recorded during voluntary and reflex contraction. Reflex contraction of the EAS was induced by means of coughing. The trials were carried out with and without a mental DT (paced auditory serial additional test). PFM contraction was recorded in two different postures: standing and sitting. During voluntary PFM contraction, reaction time (RT1), defined as latency between the stimulus and the onset of EAS EMG activity, was measured. During reflex PFM contraction, latency between the onset of external intercostal (EIC) muscle EMG activity and EAS EMG activity was measured (RT3). Concerning voluntary pelvic floor muscle contraction, there was no difference between the two positions with and without DT, except for RT1 without DT. RT1 was shorter (353.99 mv/s; 263.89-425.03) in a standing position than in a sitting position (409.86 mv/s; 361.86-461.90) (ratio 0.86, P = 0.014). Concerning reflex PFM contraction, there was no difference between standing position RT3 (-96 ms; IQR: -114: -62) and sitting position RT3 (-80 ms; IQR: -100; -51) (ratio 1.2, P = 0.225) without DT. With DT, reflex PFM was also not different (-36 vs -34 ms, ratio 1.06, P = 0.86). Body position did not influence the timing of voluntary and reflex PFM contraction during DT.

Influence of cognitive rehabilitation on pelvic floor muscle contraction: A randomized controlled trial.

Distraction task (DT), which led to a modification of voluntary and involuntary reflex pelvic floor muscle (PFM) activation, might potentiate urinary incontinence, through an alteration of the temporal course between intra-abdominal pressure and PFM contraction. We evaluated whether cognitive rehabilitation (dual-task method) could prevent the effect of a mental distraction task on the reaction time of PFM contraction. Thirty-nine healthy volunteers underwent two sessions of electromyographic (EMG) PFM recordings separated by a 2-week interval. We recorded external anal sphincter EMG activity during voluntary and involuntary PFM contraction with and without a DT (Paced Auditory Serial Addition Task). Two main parameters were recorded: RT1 (latency between an order for PFM contraction and the onset of the external anal sphincter EMG activation during voluntary PFM contraction) and RT3 (latency between the onset of the involuntary external anal sphincter EMG activation and the onset of the external intercostal muscle EMG activation during involuntary PFM contraction). Volunteers were randomized (ratio 1:2) in two groups: dual task cognitive (an attentional test, the n-back test, and PFM exercises) rehabilitation program (n = 13) and control group (n = 26). The control group had no specific instructions and did not have to do PFM exercises. Concerning voluntary PFM contraction, following a 2-week interval, in the study group RT1 in DT conditions decreased from 461.11 ms [357.14-557.41] to 290.74 ms [262.96-308.88] (ratio 0.63, P = 0.0063). In the control group, RT1 in DT conditions was not significantly different. Concerning involuntary PFM contraction, in the study group RT3 without a DT increased from -68.52 ms [-107.40; -40] to -127.78 ms [-163.06; -93.33] (ratio 1.86, P = 0.0327). In DT conditions, in the study group RT3 increased from -42.59 ms [-52.09; -6.66] to -59.25 ms [-119.44; -44.44] (ratio 1.39, P = 0.0478). The alteration of the reaction time of PFM provoked by a distraction task can be prevented by specific cognitive rehabilitation.

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.

P19.01: Reliability and validation of 3D electromagnetic tracking during voluntary and reflex pelvic floor muscle activity during dynamic whole body movements

<scp>P19</scp>.01: Reliability and validation of 3D electromagnetic tracking during voluntary and reflex pelvic floor muscle activity during dynamic whole body movements

Factors affecting reflex pelvic floor muscle contraction patterns in women with pelvic floor disorders

To explore factors affecting the presence of two reflex pelvic floor muscle contraction (PFMC) patterns in women with pelvic floor disorders. This was a retrospective analysis of pelvic floor ultrasonography and urodynamic data for 667 consecutive symptomatic women with pelvic floor disorders. We identified on ultrasonography the presence or absence of two reflex PFMC patterns, anorectal lift (ARL) and inward clitoral motion (ICM), preceding or occurring during coughing, and evaluated their associations with possible factors affecting reflex PFMC reactivity, including patient demographics, pelvic organ prolapse stages, ultrasonography findings and urodynamic data. Of the 667 women, 560 (84.0%) clearly demonstrated reflex ARL and 536 (80.4%) demonstrated ICM. There were significant differences in age (P < 0.001), parity (P = 0.033) and menopausal status (P = 0.005) between women with and those without reflex ICM before or during coughing. The multivariable logistic regression model showed that age was the only independent factor associated with presence of reflex ICM (odds ratio, 0.93 (95% CI, 0.88-0.99), P = 0.017). In contrast, no significant differences were noted between women with and without reflex ARL. Increasing age is negatively associated with the presence of reflex ICM during coughing in symptomatic women with pelvic floor disorders.

Impact of Two Reflex Pelvic Floor Muscle Contraction Patterns on Female Stress Urinary Incontinence

To explore the impact of two reflex pelvic floor muscle contraction patterns during coughing on incontinence severity and incontinence-related quality of life in women with stress urinary incontinence (SUI). A total of 208 women with the symptomatic and urodynamic evidence of SUI and 126 women with no experience of urinary incontinence were recruited in a 5-year period. During hard coughs, reflex pelvic floor muscle contraction was detected using introital ultrasound and two reflex contraction patterns were recognized: an inward clitoral motion and a superior-anterior anorectal lift. The assessment of incontinent severity and impact of quality of life included 1-hour pad tests and short forms of the Urogenital Distress Inventory and the Incontinence Impact Questionnaire. There is no significant difference in the demographics and the distribution and concordance of two reflex contractions between women with or without urinary incontinence. Neither type of reflex contraction during coughing was identified in 14 incontinent women (7%) and 5 continent women (4%). The concordant rate for synchronous activities of both reflex contractions during coughing was 80% (167) and 81% (102) for incontinent and continent women, respectively. Incontinent women without clitoral reflex motion had significantly greater incontinent severity on 1-hour pad tests (p = 0.018) and higher sum scores of the short form of Incontinence Impact Questionnaire (p = 0.026). By contrast, incontinent women with and without reflex anorectal lifts had similar incontinence severity and impact. In women with SUI, loss of clitoral reflex motion is associated with worse incontinent severity and impact.

Reflex contraction of the levator ani in women symptomatic for pelvic floor disorders

Stress urinary incontinence (SUI) is a common health problem in women. Reflex activation of muscular pelvic floor structures may play a role in preserving continence. In this study we aimed to analyze reflex pelvic floor activity on coughing in women seen for urodynamic testing. In a retrospective cohort study we analyzed the data sets of 191 women who attended a tertiary referral service for multichannel urodynamic testing and four-dimensional pelvic floor ultrasound scan between May 2009 and February 2010. Coughs were registered on volume ultrasound at a minimum of 16 Hz and analyzed by postprocessing at a later date, the operator being blinded against all clinical data. Of 175 analyzable cough volume datasets, a levator reflex was seen in 138 (79%), and clitoral reflex movement in 160 (91%). On multivariable analysis there was a significant relationship between urodynamic stress incontinence (USI) and the absence of a levator reflex (P = 0.045), and a negative relationship with the magnitude of such a reflex (P = 0.046). Reflex timing was not associated with SUI or USI. Reflex contraction of the levator ani can be observed on translabial ultrasound during sudden increases in intra-abdominal pressure. These reflex contractions are common, even in women with symptoms and signs of pelvic floor dysfunction. The observation of a levator reflex on coughing, and its magnitude, show a weak inverse association with the presence of USI.

Does childbirth alter the reflex pelvic floor response to coughing?

To determine the prevalence of and to quantify the effect of reflex pelvic floor activation on coughing in nulliparous pregnant women, and to assess peripartal changes and any association with stress urinary incontinence. Between April 2008 and March 2010, 131 nulliparous pregnant women were recruited from an antenatal clinic. All participants were interviewed and underwent four-dimensional translabial ultrasound examination at antepartum (35.8 (mean) weeks' gestation) and postpartum (4.6 (mean) months) visits. Four-dimensional ultrasound volume datasets of the pelvic floor during coughs were obtained at a minimum frame rate of 16 Hz, using a 10° volume acquisition angle. To quantify a reflex levator contraction we measured the midsagittal hiatal diameter at multiple time points. Levator integrity was determined using tomographic ultrasound imaging. From 131 women recruited, 47 datasets were technically suboptimal, leaving 84. There was a visible pelvic floor reflex in 82 (98%) cases. At the postpartum visit this was reduced to 63/84, i.e. 75% (P < 0.001). The magnitude of a reflex contraction was markedly reduced postpartum, from 4.8 mm to 2.0 mm (P < 0.001), and this effect was associated with delivery mode (P = 0.042). There was a trend towards an association between lower reflex contraction magnitude and stress incontinence (0.87 ± 3.18 mm vs. 2.36 ± 3.5 mm; P = 0.08) at the postpartum follow-up visit. Pelvic floor reflexes are altered by childbirth. This alteration may be associated with vaginal delivery. Reflex magnitude may be associated with postpartum stress urinary incontinence. The clinical significance of this finding is uncertain.

A Taiwanese-American's View of 40 Years of Electronic Fetal Monitoring

We determined the reliability of real-time ultrasound for detecting involuntary or reflex pelvic floor muscle contraction.A total of 118 women with the symptomatic and urodynamic evidence of stress urinary incontinence were recruited in a 3-year period from tertiary referral urogynecology clinics. Under the oral instruction of strong coughing involuntary pelvic floor muscle contraction was detected using introital ultrasound in real-time and cine loop modes. Two dynamic imaging features were considered involuntary pelvic floor muscle contraction, including an inward clitoral motion and a superior-anterior anorectal lift before or during coughing.Real-time ultrasound had good reliability to detect involuntary pelvic floor muscle contraction. For interobserver and intra-observer reliability Cohen's κ was 0.645 to 0.679. Of the 118 women real-time ultrasound before or during coughing showed an inward clitoral motion in 100 (93%) and an anorectal lift in 108 (92%). Neither type of contraction during coughing was identified in 2 women. Although the 2 contraction patterns were synchronized in 88% of women, for this synchronization κ was only 0.159, indicating poor coordination between these 2 involuntary activities.Real-time ultrasound is a reliable tool for detecting involuntary pelvic floor muscle contraction.

Reliability of Real-Time Ultrasound to Detect Pelvic Floor Muscle Contraction in Urinary Incontinent Women

We determined the reliability of real-time ultrasound for detecting involuntary or reflex pelvic floor muscle contraction. A total of 118 women with the symptomatic and urodynamic evidence of stress urinary incontinence were recruited in a 3-year period from tertiary referral urogynecology clinics. Under the oral instruction of strong coughing involuntary pelvic floor muscle contraction was detected using introital ultrasound in real-time and cine loop modes. Two dynamic imaging features were considered involuntary pelvic floor muscle contraction, including an inward clitoral motion and a superior-anterior anorectal lift before or during coughing. Real-time ultrasound had good reliability to detect involuntary pelvic floor muscle contraction. For interobserver and intra-observer reliability Cohen's kappa was 0.645 to 0.679. Of the 118 women real-time ultrasound before or during coughing showed an inward clitoral motion in 100 (93%) and an anorectal lift in 108 (92%). Neither type of contraction during coughing was identified in 2 women. Although the 2 contraction patterns were synchronized in 88% of women, for this synchronization kappa was only 0.159, indicating poor coordination between these 2 involuntary activities. Real-time ultrasound is a reliable tool for detecting involuntary pelvic floor muscle contraction.

Direction sensitive sensor probe for the evaluation of voluntary and reflex pelvic floor contractions

The development of a vaginal probe for the evaluation of the dynamics of pelvic floor function is described. Fundamental criteria in the design of this probe involves the incorporation of a means of assessing whether the isotonic forces closing the vagina are equally distributed or whether they are greater in some directions than others. The aim of this study is to present the design of directionally sensitive multi-sensor probe, having circumferential spatial resolution, constructed to identify the distribution of anisotropic forces acting on the vagina following voluntary and reflex pelvic floor contractions. Probe system consists of four pairs of force/displacement sensors mounted on leaf springs enabling isotonic measurements of voluntary and reflex contractions. Assembly is retractable to 23 mm for insertion, and expandable to 60 mm for measurement. Simultaneous measurements were made of force and displacement with the sensors oriented in the anterior/posterior and left/right orientation of the vagina. Using this probe, measurements were carried out to identify the temporal and spatial characteristic response of the vaginal wall. Data were analyzed with respect to voluntary pelvic floor and cough-induced contractions of nine subjects having a mean age of 64 years. A robust probe system was developed and measurements were successfully made. Initial results show that the maximum force and displacement occurs during reflex contractions in the anterior aspect of the vagina validating the anisotropic nature of the forces acting on the vaginal wall. The data also show that both the force and displacement produced by the cough-induced has a higher magnitude than voluntary pelvic floor contraction. A directional multi-sensor vaginal probe has been developed to evaluate the force and displacement produced during isotonic pelvic floor contractions. Analysis of the results provided new biomechanical data demonstrating the anisotropic nature of vaginal closure as a consequence of pelvic floor contractions.

The Clinical Application of Two-Dimensional Ultrasound Image Processing in Identifying the Response of Urogenital Structures to Voluntary and Reflex Pelvic Floor Muscle Contractions

1Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA, and School of Health Professions and Rehabilitation Sciences, Southampton University, Southampton, UK 2Department of Urology, School of Medicine, Stanford University, Stanford, CA, USA