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Yakit Yeşilyurt S, Ramazanoğlu İ, Tosun G, Özer M, Çeliker Tosun Ö. Does Pelvic Floor Muscle Exercise Change the Hemodynamic Responses of the Inferior Vena Cava in Pregnant Women? A Prospective-Controlled Study. Int Urogynecol J 2024; 35:1653-1662. [PMID: 38963506 DOI: 10.1007/s00192-024-05860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at exploring the immediate impacts of pelvic floor muscle exercises (PFMEs) on various maternal physiological parameters in pregnant women. METHODS The study included a total of 52 women, 26 pregnant (Pregnant group: 28.04±6.01 years; 26.83±3.81 kg/m2) and 26 nonpregnant (Control group: 29.42±5.73 years; 25.41±3.03 kg/m2) individuals. All women received PFME as follows: PFME was performed for 5 min (6-s holding contraction, 10 s of relaxation, 3 rapid PFM contractions). Evaluations were conducted before, immediately after, and 5 min post-exercise, with measurements including inferior vena cava (IVC) diameters and pulsatility index, blood pressure, oxygen saturation, and heart rates. Two-way analysis of variance was performed for group and time comparisons in repeated measurements. RESULTS In both groups, the IVC collapsibility index values were lower 5 min after exercise, although this decrease, although clinically significant, did not reach statistical significance (p = 0.057). Post-exercise systolic blood pressure significantly decreased in both groups, whereas diastolic blood pressure decreased significantly in the pregnant group (p = 0.001, p = 0.023). CONCLUSIONS The study found no statistically significant changes in the collapsibility index of the IVC after PFME but observed a clinically suggestive decrease. The clinical decrease in the collapsibility index can be interpreted as PFME in the supine position increasing venous return. Additionally, PFME was found not to alter maternal and fetal heart rates but contributed to the decrease in maternal systolic and diastolic blood pressure. Our study supports the view that the acute effects of PFME neither induce fetal stress nor pose maternal risks.
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Affiliation(s)
- Seda Yakit Yeşilyurt
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Izmir University of Economics, Izmir, Türkiye.
| | - İrem Ramazanoğlu
- Dokuz Eylül University Institute of Health Sciences Physical Therapy and Rehabilitation Master's Program, Izmir, Türkiye
| | - Gökhan Tosun
- Department of Gynecology and Obstetrics, Health Sciences University Izmir Tepecik Education and Research Hospital, Izmir, Türkiye
| | - Mehmet Özer
- Department of Gynecology and Obstetrics, Health Sciences University Izmir Tepecik Education and Research Hospital, Izmir, Türkiye
| | - Özge Çeliker Tosun
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Dokuz Eylül University, Izmir, Türkiye
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Förstl N, Adler I, Süß F, Dendorfer S. Technologies for Evaluation of Pelvic Floor Functionality: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:4001. [PMID: 38931784 PMCID: PMC11207910 DOI: 10.3390/s24124001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Pelvic floor dysfunction is a common problem in women and has a negative impact on their quality of life. The aim of this review was to provide a general overview of the current state of technology used to assess pelvic floor functionality. It also provides literature research of the physiological and anatomical factors that correlate with pelvic floor health. This systematic review was conducted according to the PRISMA guidelines. The PubMed, ScienceDirect, Cochrane Library, and IEEE databases were searched for publications on sensor technology for the assessment of pelvic floor functionality. Anatomical and physiological parameters were identified through a manual search. In the systematic review, 114 publications were included. Twelve different sensor technologies were identified. Information on the obtained parameters, sensor position, test activities, and subject characteristics was prepared in tabular form from each publication. A total of 16 anatomical and physiological parameters influencing pelvic floor health were identified in 17 published studies and ranked for their statistical significance. Taken together, this review could serve as a basis for the development of novel sensors which could allow for quantifiable prevention and diagnosis, as well as particularized documentation of rehabilitation processes related to pelvic floor dysfunctions.
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Affiliation(s)
- Nikolas Förstl
- OTH Regensburg—Ostbayerische Technische Hochschule Regensburg, Seybothstraße 2, 93053 Regensburg, Germany; (I.A.); (S.D.)
| | - Ina Adler
- OTH Regensburg—Ostbayerische Technische Hochschule Regensburg, Seybothstraße 2, 93053 Regensburg, Germany; (I.A.); (S.D.)
| | - Franz Süß
- OTH Regensburg—Ostbayerische Technische Hochschule Regensburg, Seybothstraße 2, 93053 Regensburg, Germany; (I.A.); (S.D.)
| | - Sebastian Dendorfer
- OTH Regensburg—Ostbayerische Technische Hochschule Regensburg, Seybothstraße 2, 93053 Regensburg, Germany; (I.A.); (S.D.)
- RCBE—Regensburg Center of Biomedical Engineering, Seybothstraße 2, 93053 Regensburg, Germany
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3
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Rai A, Sharma N, Jain SK, Lalwani A, Sharma S. Accuracy and Reliability of Different Approaches for the Assessment of Pelvic Floor Muscle Strength: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S856-S861. [PMID: 37694079 PMCID: PMC10485409 DOI: 10.4103/jpbs.jpbs_241_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 09/12/2023] Open
Abstract
There had been various methods employed for the evaluation of pelvic floor muscle (PFM) strength. The aim of the study was to do a systemic review of these methods for a better understanding of these techniques and to find the best appropriate method. A systemic review of the literature was done using three databases that included: PubMed, Scopus and Web of Science using the keywords "pelvic floor anatomy" and "functional anatomy of pelvic floor muscles" from 1985 to 2022. All the studies involved were analyzed for the methodologies used by the researcher, advantages, disadvantages, and the conclusion of the study. A total of 1,876 studies were found, out of which only 64 met the criteria of inclusion. In these studies, seven methods were used for the determination of PFM strength. These methods included: clinical palpation, perineometer, electromyography, dynamometer, ultrasonography, magnetic resonance imaging, and vaginal cones. The PFM cannot be calculated accurately using any one measuring technique. There is therefore no "gold standard" approach to PFM assessment. However, combining these methods will result in the best outcomes. According to the literature review, the most often employed procedures were digital palpation, perineometry, and Ultrasonography (USG).
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Affiliation(s)
- Alisha Rai
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Nidhi Sharma
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sanjeev Kumar Jain
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Astha Lalwani
- Department of Obs and Gynae, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sonika Sharma
- Departments of Anatomy, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
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Guo M, Zbar AP, Wu Y. Imaging the levator ani and the puborectalis muscle: implications in understanding regional anatomy, physiology and pathology. Scand J Gastroenterol 2023; 58:1295-1308. [PMID: 37309141 DOI: 10.1080/00365521.2023.2220458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
Purpose:To review the findings of recent dynamic imaging of the levator ani muscle in order to explain its function during defecation. Historical anatomical studies have suggested that the levator ani initiates defecation by lifting the anal canal, with conventional dissections and static radiologic imagery having been equated with manometry and electromyography.Materials and methods:An analysis of the literature was made concerning the chronological development of imaging modalities specifically designed to assess pelvic floor dynamics. Comparisons are made between imaging and electromyographic data at rest and during provocative manoeuvres including squeeze and strain.Results:The puborectalis muscle is shown distinctly separate from the levator ani and the deep external anal sphincter. In contrast to conventional teaching that the levator ani initiates defecation by lifting the anus, dynamic illustration defecography (DID) has confirmed that the abdominal musculature and the diaphragm instigate defecation with the transverse and vertical component portions of the levator ani resulting in descent of the anus. Current imaging has shown a tendinous peripheral structure to the termination of the conjoint longitudinal muscle, clarifying the anatomy of the perianal spaces. Planar oXy defecography has established patterns of movement of the anorectal junction that separate controls from those presenting with descending perineum syndrome or with anismus (paradoxical puborectalis spasm).Conclusions:Dynamic imaging of the pelvic floor (now mostly with MR proctography) has clarified the integral role of the levator ani during defecation. Rather than lifting the rectum, the muscle ensures descent of the anal canal.
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Affiliation(s)
- Maolin Guo
- Department of Radiology, PLA 989 Hospital, Luoyang, P.R. China
| | - Andrew P Zbar
- Department of Neuroscience and Anatomy, University of Melbourne, Melbourne, Australia
| | - Yucen Wu
- Department of Neuroscience and Anatomy, University of Melbourne, Melbourne, Australia
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Tabbakha NE, Bahillo A, Jimenez-Martin A, Garcia-Dominguez JJ, Torralba-de-Lago E, Torres-Lacomba M, Navarro-Brazalez B. A Customized System to Test Pelvic Floor Muscles Contraction: A Proof of Concept. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083113 DOI: 10.1109/embc40787.2023.10340448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Studies show that there is a high prevalence of pelvic floor dysfunctions which negatively affect the quality of life of people who suffer from them. The few sensory mechanisms that pelvic floor muscles have to inform the brain of their situation can make it difficult to perform voluntary contractions or identify risk factors. Currently, there is no consensus to improve this proprioception. This work introduces the development of a novel intravaginal device that is connected to a mobile data acquisition system and able to discern the correct contraction of the pelvic floor muscles versus contraction of adjacent muscles or abdominal thrust efforts. A cross-sectional pilot clinical study has been carried out to validate this end with healthy adult nulliparous woman with good pelvic floor muscles contraction capability in supine position.Clinical relevance- The proposed system allows a personalized and real-time assessment of the contractile capability of the pelvic floor muscles (PFM), distinguishing between muscular plans (deep/superficial PFM), between sides (right/left PFM), and between pressures from the PFM and intra-abdominal muscles (IAP). The development of an intravaginal device which is able to simultaneously measure all these features is an important advancement in this field since it can provide information in real time on the contraction capability of all the PFM as well as on the influence of the IAP during different PFM exercises.
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A biomechanical study of the birth position: a natural struggle between mother and fetus. Biomech Model Mechanobiol 2022; 21:937-951. [PMID: 35384526 DOI: 10.1007/s10237-022-01569-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/25/2022] [Indexed: 11/02/2022]
Abstract
Birth trauma affects millions of women and infants worldwide. Levator ani muscle avulsions can be responsible for long-term morbidity, associated with 13-36% of women who deliver vaginally. Pelvic floor injuries are enhanced by fetal malposition, namely persistent occipito-posterior (OP) position, estimated to affect 1.8-12.9% of pregnancies. Neonates delivered in persistent OP position are associated with an increased risk for adverse outcomes. The main goal of this work was to evaluate the impact of distinct fetal positions on both mother and fetus. Therefore, a finite element model of the fetal head and maternal structures was used to perform childbirth simulations with the fetus in the occipito-anterior (OA) and OP position of the vertex presentation, considering a flexible-sacrum maternal position. Results demonstrated that the pelvic floor muscles' stretch was similar in both cases. The maximum principal stresses were higher for the OP position, and the coccyx rotation reached maximums of 2.17[Formula: see text] and 0.98[Formula: see text] for the OP and OA positions, respectively. Concerning the fetal head, results showed noteworthy differences in the variation of diameters between the two positions. The molding index is higher for the OA position, with a maximum of 1.87. The main conclusions indicate that an OP position can be more harmful to the pelvic floor and pelvic bones from a biomechanical point of view. On the other side, an OP position can be favorable to the fetus since fewer deformations were verified. This study demonstrates the importance of biomechanical analyses to further understand the mechanics of labor.
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7
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Foster SN, Spitznagle TM, Tuttle LJ, Lowder JL, Sutcliffe S, Steger-May K, Ghetti C, Wang J, Burlis T, Meister MR, Mueller MJ, Harris-Hayes M. Pelvic Floor Mobility measured by Transperineal Ultrasound Imaging in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms. JOURNAL OF WOMEN'S HEALTH PHYSICAL THERAPY 2022; 46:100-108. [PMID: 35757164 PMCID: PMC9216208 DOI: 10.1097/jwh.0000000000000224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Women with urgency/frequency predominant lower urinary tract symptoms (UF-LUTS) may have elevated pelvic floor muscle (PFM) position at rest and limited mobility with PFM contraction and bearing down, but this has not been quantified. OBJECTIVES To compare PFM position and mobility using transperineal ultrasound (TPUS) at rest, maximal PFM contraction (perineal elevation), and bearing down (perineal descent) in women with and without UF-LUTS. We hypothesized that women with UF-LUTS would demonstrate elevated resting position and decreased excursion of pelvic landmarks during contraction and bearing down as compared to women without UF-LUTS. STUDY DESIGN Case-control study. METHODS Women with UF-LUTS were matched 1:1 on age, body mass index and vaginal parity to women without UF-LUTS. TPUS videos were obtained during 3 conditions: rest, PFM contraction, and bearing down. Levator plate angle (LPA) and puborectalis length (PR length), were measured for each condition. Paired t-tests or Wilcoxon signed rank tests compared LPA and PR length between cases and controls. RESULTS 21 case-control pairs (42 women): Women with UF-LUTS demonstrated greater LPA at rest (66.8 ± 13.2 degrees vs 54.9 ± 9.8 degrees; P=0.006), and less PR lengthening from rest to bearing down (0.2 ± 3.1 mm vs 2.1 ± 2.9 mm; P=.03). CONCLUSION Women with UF-LUTS demonstrated more elevated (cranioventral) position of the PFM at rest and less PR muscle lengthening with bearing down. These findings highlight the importance of a comprehensive PFM examination and possible treatment for women with UF-LUTS to include PFM position and mobility.
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Affiliation(s)
- Stefanie N Foster
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
| | - Theresa M Spitznagle
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
| | - Lori J Tuttle
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA
| | - Jerry L Lowder
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
- Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St Louis, MO
| | - Siobhan Sutcliffe
- Department of Surgery, Washington University in St. Louis, St Louis, MO
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
| | - Karen Steger-May
- Division of Biostatistics, Washington University in St. Louis, St Louis, MO
| | - Chiara Ghetti
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
- Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St Louis, MO
| | - Jinli Wang
- Division of Biostatistics, Washington University in St. Louis, St Louis, MO
| | - Taylor Burlis
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
| | - Melanie R Meister
- Department Obstetrics and Gynecology, Washington University in St. Louis, St Louis, MO
- Division of Female Pelvic Medicine & Reconstructive Surgery, Washington University in St. Louis, St Louis, MO
| | - Michael J Mueller
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
- Department of Radiology, Washington University in St. Louis, St Louis, MO
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University in St. Louis, St Louis, MO
- Department Orthopedic Surgery, Washington University in St. Louis, St Louis, MO
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8
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Mittal RK, Tuttle LJ. Anorectal Anatomy and Function. Gastroenterol Clin North Am 2022; 51:1-23. [PMID: 35135656 DOI: 10.1016/j.gtc.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Anatomy of pelvic floor muscles has long been controversial. Novel imaging modalities, such as three-dimensional transperineal ultrasound imaging, MRI, and diffusion tensor imaging, have revealed unique myoarchitecture of the external anal sphincter and puborectalis muscle. High-resolution anal manometry, high-definition anal manometry, and functional luminal imaging probe are important new tools to assess anal sphincter and puborectalis muscle function. Increased understanding of the structure and function of anal sphincter complex/pelvic floor muscle has improved the ability to diagnose patients with pelvic floor disorders. New therapeutic modalities to treat anal/fecal incontinence and other pelvic floor disorders will emerge in the near future.
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Affiliation(s)
- Ravinder K Mittal
- Department of Medicine/Gastroenterology, University of California, San Diego, ACTRI, 9500 Gilman Drive, MC 0061, La Jolla, CA 92093-0990, USA.
| | - Lori J Tuttle
- Department of Medicine/Gastroenterology, University of California, San Diego, USA; San Diego State University, San Diego, CA, USA
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Vesting S, Olsen MF, Gutke A, Rembeck G, Larsson MEH. Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study. BMJ Open 2021; 11:e049082. [PMID: 34475166 PMCID: PMC8413957 DOI: 10.1136/bmjopen-2021-049082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Evaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum. DESIGN A multicentre inter-rater reliability study. SETTING Three primary care rehabilitation centres in Sweden. PARTICIPANTS A total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order. OUTCOME MEASURES Inter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging). RESULTS Vaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres. CONCLUSIONS Vaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging. TRIAL REGISTRATION NUMBER NCT03703804.
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Affiliation(s)
- Sabine Vesting
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Gibraltar Rehabilitation, Gothenburg, Sweden
| | - Monika Fagevik Olsen
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Therapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Gastrosurgical Research & Education, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gun Rembeck
- Region Västra Götaland, Research and Development Centre Södra Älvsborg, Borås, Sweden
- Region Västra Götaland, Regionhälsan Borås Youth Centre, Borås, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland Education, Research and Development Primary Health Care, Gothenburg, Sweden
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White WD, Avery M, Jonely H, Mansfield JT, Sayal PK, Desai MJ. The interdisciplinary management of coccydynia: A narrative review. PM R 2021; 14:1143-1154. [PMID: 34333873 DOI: 10.1002/pmrj.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022]
Abstract
Pain that develops in the coccyx or surrounding tissues is known as coccydynia, which occurs as a result of many etiologies both traumatic and nontraumatic. Although coccydynia most commonly affects middle-aged women, it may be found in both sexes and in all age groups. The aim of this article is to provide an overview of the presentation, diagnostic imaging, and pathophysiology of coccydynia, and to comprehensively review the current treatment options. A review of publications from 1990 to 2020 using search words related to the treatment of coccydynia in PubMed and Google Scholar was completed. Level II evidence was found supporting stretching, manipulation, and extracorporeal shock wave therapy. There are no data from high-quality studies to support injection-based therapy including corticosteroids, prolotherapy, nerve blocks, and radiofrequency ablation, although there are small retrospective and prospective observational studies suggesting benefit. Level III evidence was found supporting coccygectomy for chronic/refractory coccydynia. There are no data from randomized controlled trials to support the use of neuromodulation (sacral burst and dorsal root ganglion stimulation), although there are case reports suggesting benefit. High-level, comparative studies are lacking to guide the treatment of coccydynia and should be a focus for future research studies.
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Affiliation(s)
- William D White
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Melinda Avery
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Holly Jonely
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - John T Mansfield
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Puneet K Sayal
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Three-dimensional evaluation of the coccyx movement between supine and standing positions using conventional and upright computed tomography imaging. Sci Rep 2021; 11:6886. [PMID: 33767271 PMCID: PMC7994836 DOI: 10.1038/s41598-021-86312-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Currently, no three-dimensional reference data exist for the normal coccyx in the standing position on computed tomography (CT); however, this information could have utility for evaluating patients with coccydynia and pelvic floor dysfunction. Thus, we aimed to compare coccygeal parameters in the standing versus supine positions using upright and supine CT and evaluate the effects of sex, age, and body mass index (BMI) on coccygeal movement. Thirty-two healthy volunteers underwent both upright (standing position) and conventional (supine position) CT examinations. In the standing position, the coccyx became significantly longer and straighter, with the tip of the coccyx moving backward and downward (all p < 0.001). Additionally, the coccygeal straight length (standing/supine, 37.8 ± 7.1/35.7 ± 7.0 mm) and sacrococcygeal straight length (standing/supine, 131.7 ± 11.2/125.0 ± 10.7 mm) were significantly longer in the standing position. The sacrococcygeal angle (standing/supine, 115.0 ± 10.6/105.0 ± 12.5°) was significantly larger, while the lumbosacral angle (standing/supine, 21.1 ± 5.9/25.0 ± 4.9°) was significantly smaller. The migration length of the tip of the coccyx (mean, 7.9 mm) exhibited a moderate correlation with BMI (r = 0.42, p = 0.0163). Our results may provide important clues regarding the pathogenesis of coccydynia and pelvic floor dysfunction.
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12
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Borges M, Moura R, Oliveira D, Parente M, Mascarenhas T, Natal R. Effect of the birthing position on its evolution from a biomechanical point of view. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105921. [PMID: 33422852 DOI: 10.1016/j.cmpb.2020.105921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE During vaginal delivery, several positions can be adopted by the mother to be more comfortable and to help the labor process. The positions chosen are very influenced by factors such as monitoring and intervention during the second stage of labor. However, there is limited evidence to support the most ideal birthing position. This work aims at contributing to a better knowledge associated with the widening of the pubic symphysis and the biomechanics of flexible and non-flexible sacrum positions that can be adopted during the second stage of labor, as well as their resulting pathophysiological consequences. METHODS A validated computational model composed by the pelvic floor muscles attached to the bones, and a fetus head was used to simulate vaginal deliveries. This model was modified to mimic two birthing positions: one that allows the free movement of the coccyx as in flexible sacrum positions and other in which this movement is more restricted as in non-flexible sacrum positions. The widening of the pubic symphysis was also considered to facilitate the passage of the fetus head. RESULTS The results obtained showed that, in non-flexible sacrum positions, where the coccyx movement is restricted, occur a rotation of 3.6° of the coccyx and a widening of 6 mm of the pubic symphysis. In contrast, in flexible sacrum positions, where the coccyx is free to move, occur a rotation of 15.7° of the coccyx and a widening of the pubic symphysis of 3 mm, appearing to be more beneficial for the mother's pelvis, but slightly higher stresses were detected in the pelvic floor muscles. CONCLUSIONS Globally, the results obtained allow to conclude that different birthing positions lead to changes in the female pelvic space, so certain positions can be adopted by the mother during the second stage of labor to reduce the risk of obstructed labor and the development of several dysfunctions. More specifically, flexible sacrum positions, such as kneeling, standing, squatting and sitting positions, are more beneficial for the bone structure of her pelvis as they allow a higher coccyx movement and lower widening of the pubic symphysis.
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Affiliation(s)
- Margarida Borges
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal.
| | - Rita Moura
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
| | - Dulce Oliveira
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
| | - Marco Parente
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
| | - Teresa Mascarenhas
- Centro Hospitalar Universitário de São João, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Renato Natal
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
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Persistent levator co-activation is not associated with symptoms or bother of obstructed defecation. Int Urogynecol J 2020; 31:2611-2615. [DOI: 10.1007/s00192-020-04389-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023]
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14
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Cardiovascular responses to pelvic floor muscle contraction in healthy women: Prospective study. Eur J Obstet Gynecol Reprod Biol 2020; 252:36-42. [PMID: 32559601 DOI: 10.1016/j.ejogrb.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Analyze the acute heart rate and blood pressure responses to two protocols of pelvic floor muscles contractions in premenopausal and postmenopausal women. METHODS Fifty-four women without pelvic floor muscles disorders were eligible and allocated into two groups: premenopausal and postmenopausal. The groups underwent two protocols and the pelvic floor muscle endurance, heart rate, and blood pressure values were monitored. Both protocols included 10 pelvic floor muscles contractions; one series contained contractions lasting 5 s with 5 s of rest between each contraction and the other series contained contractions lasting 10 s with 10 s of rest. RESULTS In both groups, there was a significant increase in the heart rate during pelvic floor muscles contractions (premenopausal: 71.0 ± 7.3 and 80.3 ± 7.7; postmenopausal: 65.4 ± 6.6 and 73.6 ± 6.6, at rest and contractions peak, respectively) and in systolic blood pressure immediately after the contractions. The observed values during exercise returned to basal values seconds after the contractions. A positive correlation between heart rate and vaginal squeeze pressure (r = 0.45, p = 0.0007 and r = 0.48, p = 0.0003, 5- and 10-s series, respectively) was observed. CONCLUSION The proposed protocol of isometric pelvic floor muscles contractions caused an increase in heart rate and blood pressure within the normal range and might not represent a cardiovascular risk for healthy postmenopausal women without urinary incontinence and without cardiovascular dysfunctions.
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Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy 2019; 105:315-320. [DOI: 10.1016/j.physio.2018.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 08/19/2018] [Indexed: 11/21/2022]
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Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018; 10:CD005654. [PMID: 30288727 PMCID: PMC6516955 DOI: 10.1002/14651858.cd005654.pub4] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed urinary incontinence (MUI) and, less commonly, urgency urinary incontinence (UUI).This is an update of a Cochrane Review first published in 2001 and last updated in 2014. OBJECTIVES To assess the effects of PFMT for women with urinary incontinence (UI) in comparison to no treatment, placebo or sham treatments, or other inactive control treatments; and summarise the findings of relevant economic evaluations. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register (searched 12 February 2018), which contains trials identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings, and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in women with SUI, UUI or MUI (based on symptoms, signs or urodynamics). One arm of the trial included PFMT. Another arm was a no treatment, placebo, sham or other inactive control treatment arm. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials for eligibility and risk of bias. We extracted and cross-checked data. A third review author resolved disagreements. We processed data as described in the Cochrane Handbook for Systematic Reviews of Interventions. We subgrouped trials by diagnosis of UI. We undertook formal meta-analysis when appropriate. MAIN RESULTS The review included 31 trials (10 of which were new for this update) involving 1817 women from 14 countries. Overall, trials were of small-to-moderate size, with follow-ups generally less than 12 months and many were at moderate risk of bias. There was considerable variation in the intervention's content and duration, study populations and outcome measures. There was only one study of women with MUI and only one study with UUI alone, with no data on cure, cure or improvement, or number of episodes of UI for these subgroups.Symptomatic cure of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were eight times more likely to report cure (56% versus 6%; risk ratio (RR) 8.38, 95% confidence interval (CI) 3.68 to 19.07; 4 trials, 165 women; high-quality evidence). For women with any type of UI, PFMT groups were five times more likely to report cure (35% versus 6%; RR 5.34, 95% CI 2.78 to 10.26; 3 trials, 290 women; moderate-quality evidence).Symptomatic cure or improvement of UI at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT groups were six times more likely to report cure or improvement (74% versus 11%; RR 6.33, 95% CI 3.88 to 10.33; 3 trials, 242 women; moderate-quality evidence). For women with any type of UI, PFMT groups were two times more likely to report cure or improvement than women in the control groups (67% versus 29%; RR 2.39, 95% CI 1.64 to 3.47; 2 trials, 166 women; moderate-quality evidence).UI-specific symptoms and quality of life (QoL) at the end of treatment: compared with no treatment or inactive control treatments, women with SUI who were in the PFMT group were more likely to report significant improvement in UI symptoms (7 trials, 376 women; moderate-quality evidence), and to report significant improvement in UI QoL (6 trials, 348 women; low-quality evidence). For any type of UI, women in the PFMT group were more likely to report significant improvement in UI symptoms (1 trial, 121 women; moderate-quality evidence) and to report significant improvement in UI QoL (4 trials, 258 women; moderate-quality evidence). Finally, for women with mixed UI treated with PFMT, there was one small trial (12 women) reporting better QoL.Leakage episodes in 24 hours at the end of treatment: PFMT reduced leakage episodes by one in women with SUI (mean difference (MD) 1.23 lower, 95% CI 1.78 lower to 0.68 lower; 7 trials, 432 women; moderate-quality evidence) and in women with all types of UI (MD 1.00 lower, 95% CI 1.37 lower to 0.64 lower; 4 trials, 349 women; moderate-quality evidence).Leakage on short clinic-based pad tests at the end of treatment: women with SUI in the PFMT groups lost significantly less urine in short (up to one hour) pad tests. The comparison showed considerable heterogeneity but the findings still favoured PFMT when using a random-effects model (MD 9.71 g lower, 95% CI 18.92 lower to 0.50 lower; 4 trials, 185 women; moderate-quality evidence). For women with all types of UI, PFMT groups also reported less urine loss on short pad tests than controls (MD 3.72 g lower, 95% CI 5.46 lower to 1.98 lower; 2 trials, 146 women; moderate-quality evidence).Women in the PFMT group were also more satisfied with treatment and their sexual outcomes were better. Adverse events were rare and, in the two trials that did report any, they were minor. The findings of the review were largely supported by the 'Summary of findings' tables, but most of the evidence was downgraded to moderate on methodological grounds. The exception was 'participant-perceived cure' in women with SUI, which was rated as high quality. AUTHORS' CONCLUSIONS Based on the data available, we can be confident that PFMT can cure or improve symptoms of SUI and all other types of UI. It may reduce the number of leakage episodes, the quantity of leakage on the short pad tests in the clinic and symptoms on UI-specific symptom questionnaires. The authors of the one economic evaluation identified for the Brief Economic Commentary reported that the cost-effectiveness of PFMT looks promising. The findings of the review suggest that PFMT could be included in first-line conservative management programmes for women with UI. The long-term effectiveness and cost-effectiveness of PFMT needs to be further researched.
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Affiliation(s)
- Chantale Dumoulin
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - Licia P Cacciari
- University of MontrealSchool of Rehabilitation, Faculty of MedicineC.P.6128 Succ. Centre‐villeMontrealQCCanadaH3C 3J7
| | - E Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineWellingtonNew Zealand
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Ben Ami N, Dar G. What is the most effective verbal instruction for correctly contracting the pelvic floor muscles? Neurourol Urodyn 2018; 37:2904-2910. [DOI: 10.1002/nau.23810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/05/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Noa Ben Ami
- Faculty of Health Sciences; Department of Physiotherapy; Ariel University; Ariel Israel
| | - Gali Dar
- Faculty of Social Welfare and Health Studies, Department of Physiotherapy; Haifa University; Haifa Israel
- Ribstein Center for Research and Sports Medicine; Wingate Institute; Netanya Israel
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18
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Predictive role of measurement of pelvic floor muscle thickness with static MRI in stress and mixed urinary incontinence. Int Urogynecol J 2018; 30:271-277. [DOI: 10.1007/s00192-018-3663-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 01/04/2018] [Indexed: 10/16/2022]
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19
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Fujisaki A, Shigeta M, Shimoinaba M, Yoshimura Y. Influence of adequate pelvic floor muscle contraction on the movement of the coccyx during pelvic floor muscle training. J Phys Ther Sci 2018; 30:544-548. [PMID: 29706703 PMCID: PMC5908999 DOI: 10.1589/jpts.30.544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/13/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Pelvic floor muscle training is a first-line therapy for female stress urinary incontinence. Previous studies have suggested that the coccyx tip moves ventrally and cranially during pelvic floor muscle contraction. The study aimed to elucidate the influence of adequate pelvic floor muscle contraction on coccyx movement. [Subjects and Methods] Sixty-three females (57 patients with stress urinary incontinence and additional 6 healthy volunteers) were enrolled. Using magnetic resonance imaging, coccyx movement was evaluated during pelvic floor muscle contraction and strain. An adequate contraction was defined as a contraction with good Oxford grading scale [≥3] and without inadequate muscle substitution patterns. [Results] Inadequate muscle substitution patterns were observed in 33 participants (52.4%). No significant difference was observed in the movement of the coccyx tip in the ventrodorsal direction between females with and without inadequate muscle substitution patterns. However, a significant increase in the movement of the coccyx tip in the cranial direction was detected in the group without inadequate muscle substitution patterns. Compared to participants with inadequate pelvic floor muscle contraction, those who had adequate pelvic floor muscle contraction exhibited significantly increased cranial movement of the coccyx. [Conclusion] Adequate pelvic floor muscle contraction can produce cranial movement of the coccyx tip.
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Affiliation(s)
- Akiko Fujisaki
- Department of Urology, Yotsuya Medical Cube: 7-7 Nibancho, Chiyoda-ku, Tokyo 102-0084, Japan
| | | | - Misa Shimoinaba
- Department of Urology, Yotsuya Medical Cube: 7-7 Nibancho, Chiyoda-ku, Tokyo 102-0084, Japan
| | - Yasukuni Yoshimura
- Department of Urology, Yotsuya Medical Cube: 7-7 Nibancho, Chiyoda-ku, Tokyo 102-0084, Japan
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20
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Silva M, Parente M, Brandão S, Mascarenhas T, Natal Jorge R. Characterization of the passive and active material parameters of the pubovisceralis muscle using an inverse numerical method. J Biomech 2018; 71:100-110. [DOI: 10.1016/j.jbiomech.2018.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 12/11/2017] [Accepted: 01/28/2018] [Indexed: 12/28/2022]
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Abstract
Urinary incontinence, defined as involuntary leakage of urine, is often considered a disorder of post-partum and post-menopausal women. However, this disorder is not exclusive to older women, as recent research has demonstrated a high prevalence of urinary incontinence among young, nulliparous female athletes. In fact, females participating in repetitive, high-impact sports are at the highest risk for urinary incontinence. In these athletes, the absence of sufficient pelvic floor strength and coordination to withstand sport related increases in intra-abdominal pressure results in physical activity related urinary incontinence, and may be a predictor of urinary incontinence in later adulthood. Pelvic floor dysfunction and urinary incontinence in this population is under-reported and consequently under-diagnosed and under-treated. Therefore, the prevalence is higher than one might expect, and the effects can include decreased performance, change in sport and avoidance of physical activity all together. This manuscript highlights the prevalence of pelvic floor dysfunction and outlines its pathophysiology, diagnosis, treatment, and rehabilitation. We discuss how greater recognition of this disorder by health care providers and routinely querying active females is a critical step in addressing this issue. Identification, education and appropriate rehabilitation can positively affect outcomes in regards to urinary incontinence symptoms and maintain physical activity participation in these athletes.
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Affiliation(s)
- Ellen K Casey
- a Department of Physical Medicine and Rehabilitation , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Kate Temme
- a Department of Physical Medicine and Rehabilitation , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
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22
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Ptak M, Brodowska A, Ciećwież S, Rotter I. Quality of Life in Women with Stage 1 Stress Urinary Incontinence after Application of Conservative Treatment-A Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E577. [PMID: 28556806 PMCID: PMC5486263 DOI: 10.3390/ijerph14060577] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 01/08/2023]
Abstract
Stress urinary incontinence (SUI) influences quality of life in female patients. In this study, we used ICIQ LUTS QoL (The International Consultation Incontinence Questionnaire Lower Urinary Tract Symptoms quality of life) to determine the quality of life (QoL) in various domains in patients with stage 1 SUI. The study included 140 perimenopausal women subjected to urodynamic tests at the Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police (Poland) in 2013-2015. The study subjects were divided into two groups, A and B. Each patient completed two questionnaires, an original survey developed by the authors and the validated ICIQ LUTS QoL. Two exercise programs, each lasting for 3 months and consisting of 4 weekly sessions, were recommended to the study subjects. The program for Group A included exercises for pelvic floor muscles (PFM) with simultaneous tension of the transverse abdominal muscle (TrA), and the program for Group B, PFM exercises without TrA tension. After completing the exercise programs, patients with stage 1 SUI, both from Group A and from Group B, showed a significant improvement in most QoL domains measured with ICIQ LUTS QoL. However, more beneficial effects of the training were observed in the group subjected to PFM exercises with TrA tension.
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Affiliation(s)
- Magdalena Ptak
- Department of Medical Rehabilitation, Pomeranian Medical University, Szczecin, 71-210, Poland.
| | - Agnieszka Brodowska
- Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police, 72-010, Poland.
| | - Sylwester Ciećwież
- Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police, 72-010, Poland.
| | - Iwona Rotter
- Department of Medical Rehabilitation, Pomeranian Medical University, Szczecin, 71-210, Poland.
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Deegan EG, Stothers L, Kavanagh A, Macnab AJ. Quantification of pelvic floor muscle strength in female urinary incontinence: A systematic review and comparison of contemporary methodologies. Neurourol Urodyn 2017; 37:33-45. [DOI: 10.1002/nau.23285] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/20/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Emily G. Deegan
- Department of Experimental Medicine, International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Lynn Stothers
- Department of Urological Sciences, Principal Investigator, International Collaboration on Repair Discoveries (ICORD)University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Alex Kavanagh
- Stellenbosch Institute for Advanced StudyWallenberg Research CentreStellenboschSouth Africa
| | - Andrew J. Macnab
- Stellenbosch Institute for Advanced StudyWallenberg Research CentreStellenboschSouth Africa
- Department of Urologic SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Pubovisceralis Muscle Fiber Architecture Determination: Comparison Between Biomechanical Modeling and Diffusion Tensor Imaging. Ann Biomed Eng 2017; 45:1255-1265. [DOI: 10.1007/s10439-016-1788-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/31/2016] [Indexed: 12/19/2022]
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Halski T, Ptaszkowski K, Słupska L, Dymarek R, Paprocka-Borowicz M. Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study. Clin Interv Aging 2017; 12:75-83. [PMID: 28115836 PMCID: PMC5221554 DOI: 10.2147/cia.s121467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position. Materials and methods This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance. Results In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104). Conclusion The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM.
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Affiliation(s)
- Tomasz Halski
- Department of Physiotherapy, Opole Medical School, Opole
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders
| | - Lucyna Słupska
- Department of Physiotherapy, Opole Medical School, Opole
| | - Robert Dymarek
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Bladder Control Problems in Elders. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ptaszkowski K, Paprocka-Borowicz M, Słupska L, Bartnicki J, Dymarek R, Rosińczuk J, Heimrath J, Dembowski J, Zdrojowy R. Assessment of bioelectrical activity of synergistic muscles during pelvic floor muscles activation in postmenopausal women with and without stress urinary incontinence: a preliminary observational study. Clin Interv Aging 2015; 10:1521-8. [PMID: 26445533 PMCID: PMC4590414 DOI: 10.2147/cia.s89852] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Muscles such as adductor magnus (AM), gluteus maximus (GM), rectus abdominis (RA), and abdominal external and internal oblique muscles are considered to play an important role in the treatment of stress urinary incontinence (SUI), and the relationship between contraction of these muscles and pelvic floor muscles (PFM) has been established in previous studies. Synergistic muscle activation intensifies a woman's ability to contract the PFM. In some cases, even for continent women, it is not possible to fully contract their PFM without involving the synergistic muscles. The primary aim of this study was to assess the surface electromyographic activity of synergistic muscles to PFM (SPFM) during resting and functional PFM activation in postmenopausal women with and without SUI. MATERIALS AND METHODS This study was a preliminary, prospective, cross-sectional observational study and included volunteers and patients who visited the Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Forty-two patients participated in the study and were screened for eligibility criteria. Thirty participants satisfied the criteria and were categorized into two groups: women with SUI (n=16) and continent women (n=14). The bioelectrical activity of PFM and SPFM (AM, RA, GM) was recorded with a surface electromyographic instrument in a standing position during resting and functional PFM activity. RESULTS Bioelectrical activity of RA was significantly higher in the incontinent group than in the continent group. These results concern the RA activity during resting and functional PFM activity. The results for other muscles showed no significant difference in bioelectrical activity between groups. CONCLUSION In women with SUI, during the isolated activation of PFM, an increased synergistic activity of RA muscle was observed; however, this activity was not observed in asymptomatic women. This may indicate the important accessory contribution of these muscles in the mechanism of continence.
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Affiliation(s)
- Kuba Ptaszkowski
- Department of Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Małgorzata Paprocka-Borowicz
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Lucyna Słupska
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Janusz Bartnicki
- Department of Obstetrics, Wroclaw Medical University, Wroclaw, Poland ; Department of Obstetrics and Gynecology, Health Center Bitterfeld/Wolfen gGmbH, Bitterfeld-Wolfen, Germany
| | - Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Heimrath
- Department of Gynaecology and Obstetrics, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Janusz Dembowski
- Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
| | - Romuald Zdrojowy
- Department and Clinic of Urology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
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Park H, Han D. The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. J Phys Ther Sci 2015; 27:2113-5. [PMID: 26311935 PMCID: PMC4540829 DOI: 10.1589/jpts.27.2113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/24/2015] [Indexed: 12/02/2022] Open
Abstract
[Purpose] This study was conducted to investigate the effect of the correlation between
the pelvic floor muscles (PFM) and diaphragmatic motion during breathing. [Subjects] The
subjects of this study were 20 healthy female students who listened to an explanation of
the study methods, purpose and agreed to participate in the experiment. [Methods]
Radiograph equipment was used to examine diaphragmatic motion with contraction of the PFM
during breathing, and a spirometer was used to examine lung vital capacity. [Results] The
results revealed a significant change in the diaphragmatic motion and pulmonary function
(FEV1, MVV). FEV1 and MVV showed significant differences when the
PFM was contracted. Diaphragmatic motion showed a significant difference when the PFM was
contracted. [Conclusion] Diaphragmatic motion and contraction of the PFM correlate with
breathing. In addition, breathing is much more effective during contraction of the PFM.
Therefore, PFM strengthening exercises should be included in respiratory rehabilitation
programs.
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Affiliation(s)
- Hankyu Park
- Department of Physical Therapy, Graduate School of Rehabilitation Science, Daegu University, Republic of Korea
| | - Dongwook Han
- Department of Physical Therapy, College of Health and Welfare, Silla University, Republic of Korea
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Pelvic floor muscle displacement during voluntary and involuntary activation in continent and incontinent women: a systematic review. Int Urogynecol J 2015; 26:1587-98. [PMID: 25994628 DOI: 10.1007/s00192-015-2700-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Investigations of the dynamic function of female pelvic floor muscles (PFM) help us to understand the pathophysiology of stress urinary incontinence (SUI). Displacement measurements of PFM give insight into muscle activation and thus help to improve rehabilitation strategies. This systematic review (PROSPERO 2013: CRD42013006409) was performed to summarise the current evidence for PFM displacement during voluntary and involuntary activation in continent and incontinent women. METHODS MEDLINE, EMBASE, Cochrane and SPORTDiscus databases were searched using selected terminology reflecting the PICO approach. Screening of Google Scholar and congress abstracts added to further information. Original articles investigating PFM displacement were included if they reported on at least one of the aims of the review, e.g., method, test position, test activity, direction and quantification of displacement, as well as the comparison between continent and incontinent women. Titles and abstracts were screened by two reviewers. The papers included were reviewed by two individuals to ascertain whether they fulfilled the inclusion criteria and data were extracted on outcome parameters. RESULTS Forty-two predominantly observational studies fulfilled the inclusion criteria. A variety of measurement methods and calculations of displacement was presented. The sample was heterogeneous concerning age, parity and continence status. Test positions and test activities varied among the studies. CONCLUSIONS The findings summarise the present knowledge of PFM displacement, but still lack deeper comprehension of the SUI pathomechanism of involuntary, reflexive activation during functional activities. We therefore propose that future investigations focus on PFM dynamics during fast and stressful impact tasks.
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Affiliation(s)
- Thomas Johan Kibsgård
- Department of Orthopedics Oslo University Hospital Songsvannsveien 20, NO-0372, Oslo , Norway
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Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2014:CD005654. [PMID: 24823491 DOI: 10.1002/14651858.cd005654.pub3] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed and, less commonly, urgency urinary incontinence. OBJECTIVES To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL) (1999 onwards), MEDLINE (1966 onwards) and MEDLINE In-Process (2001 onwards), and handsearched journals and conference proceedings (searched 15 April 2013) and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised trials in women with stress, urgency or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm. DATA COLLECTION AND ANALYSIS Trials were independently assessed by two review authors for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. Trials were subgrouped by diagnosis of urinary incontinence. Formal meta-analysis was undertaken when appropriate. MAIN RESULTS Twenty-one trials involving 1281 women (665 PFMT, 616 controls) met the inclusion criteria; 18 trials (1051 women) contributed data to the forest plots. The trials were generally small to moderate sized, and many were at moderate risk of bias, based on the trial reports. There was considerable variation in the interventions used, study populations, and outcome measures. There were no studies of women with mixed or urgency urinary incontinence alone.Women with SUI who were in the PFMT groups were 8 times more likely than the controls to report that they were cured (46/82 (56.1%) versus 5/83 (6.0%), RR 8.38, 95% CI 3.68 to 19.07) and 17 times more likely to report cure or improvement (32/58 (55%) versus 2/63 (3.2%), RR 17.33, 95% CI 4.31 to 69.64). In trials in women with any type of urinary incontinence, PFMT groups were also more likely to report cure, or more cure and improvement than the women in the control groups, although the effect size was reduced. Women with either SUI or any type of urinary incontinence were also more satisfied with the active treatment, while women in the control groups were more likely to seek further treatment. Women treated with PFMT leaked urine less often, lost smaller amounts on the short office-based pad test, and emptied their bladders less often during the day. Their sexual outcomes were also better. Two trials (one small and one moderate size) reported some evidence of the benefit persisting for up to a year after treatment. Of the few adverse effects reported, none were serious.The findings of the review were largely supported by the summary of findings tables, but most of the evidence was down-graded to moderate on methodological grounds. The exception was 'Participant perceived cure' in women with SUI, which was rated as high quality. AUTHORS' CONCLUSIONS The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress and any type of urinary incontinence. Long-term effectiveness of PFMT needs to be further researched.
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Affiliation(s)
- Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, C.P.6128 Succ. Centre-ville, Montreal, Quebec, Canada, H3C 3J7
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Ferreira CH, Naldoni LM, Ribeiro JDS, Meirelles MCC, Cavalli RDC, Bø K. Maternal blood pressure and heart rate response to pelvic floor muscle training during pregnancy. Acta Obstet Gynecol Scand 2014; 93:678-83. [DOI: 10.1111/aogs.12388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 03/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Cristine H. Ferreira
- Ribeirão Preto Medical School; Department of Biomechanics, Medicine and Rehabilitation, Physiotherapy Course; University of São Paulo; São Paulo Brazil
| | - Luciane M.V. Naldoni
- Rehabilitation and Functional Performance Program; Faculty of Medicine of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - Juliana dos Santos Ribeiro
- Rehabilitation and Functional Performance Program; Faculty of Medicine of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | | | - Ricardo de Carvalho Cavalli
- Ribeirão Preto Medical School; Department of Gynecology and Obstetrics; University of São Paulo; São Paulo Brazil
| | - Kari Bø
- Department of Sports Medicine; Norwegian School of Sport Sciences; Oslo Norway
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Mittal RK, Bhargava V, Sheean G, Ledgerwood M, Sinha S. Purse-string morphology of external anal sphincter revealed by novel imaging techniques. Am J Physiol Gastrointest Liver Physiol 2014; 306:G505-14. [PMID: 24458022 PMCID: PMC3949029 DOI: 10.1152/ajpgi.00338.2013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The external anal sphincter (EAS) may be injured in 25-35% of women during the first and subsequent vaginal childbirths and is likely the most common cause of anal incontinence. Since its first description almost 300 years ago, the EAS was believed to be a circular or a "donut-shaped" structure. Using three-dimensional transperineal ultrasound imaging, MRI, diffusion tensor imaging, and muscle fiber tracking, we delineated various components of the EAS and their muscle fiber directions. These novel imaging techniques suggest "purse-string" morphology, with "EAS muscles" crossing contralaterally in the perineal body to the contralateral transverse perineal (TP) and bulbospongiosus (BS) muscles, thus attaching the EAS to the pubic rami. Spin-tag MRI demonstrated purse-string action of the EAS muscle. Electromyography of TP/BS and EAS muscles revealed their simultaneous contraction and relaxation. Lidocaine injection into the TP/BS muscle significantly reduced anal canal pressure. These studies support purse-string morphology of the EAS to constrict/close the anal canal opening. Our findings have implications for the effect of episiotomy on anal closure function and the currently used surgical technique (overlapping sphincteroplasty) for EAS reconstructive surgery to treat anal incontinence.
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Affiliation(s)
- Ravinder K. Mittal
- 1Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California; ,4San Diego Veterans Affairs Healthcare System, San Diego, California
| | - Valmik Bhargava
- 1Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California; ,4San Diego Veterans Affairs Healthcare System, San Diego, California
| | - Geoff Sheean
- 2Department of Neurology, University of California San Diego, San Diego, California;
| | - Melissa Ledgerwood
- 1Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, California;
| | - Shantanu Sinha
- 3Department of Radiology, University of California San Diego, San Diego, California; and
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Stensgaard SH, Moeller Bek K, Ismail KM. Coccygeal movement test: an objective, non-invasive test for localization of the pelvic floor muscles in healthy women. Med Princ Pract 2014; 23:318-22. [PMID: 24852386 PMCID: PMC5586893 DOI: 10.1159/000362337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 03/19/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the use of palpation of the coccyx (the coccygeal movement test, CMT) as a possible objective screening tool for the assessment of adequate localization of the pelvic floor muscles (PFMs). SUBJECTS AND METHODS Twenty-four healthy female volunteers, known to be able to locate their PFMs, were given instructions (allocated at random) to perform a 'correct contraction', 'straining' or 'nothing' when examined by six independent assessors using the CMT. The assessors were blinded to the instructions and to the test results recorded by other assessors. Data were available for 137 observations, and these were dichotomized into either 'able to contract' ('correct contraction') or 'not able to contract' ('straining' or 'nothing'). This information was used to calculate the sensitivity, specificity and positive and negative predictive values for the CMT. RESULTS The CMT correctly identified 56/58 observations when women did not perform the contraction of the PFMs compared to 61/79 observations when they did. Hence, the sensitivity and specificity were 97 and 77%, respectively. CONCLUSION This study showed that the CMT was a useful test to identify women who were able to localize their PFMs compared to those who were not, making it a potentially useful initial screening test in structured training programmes for the PFMs.
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Affiliation(s)
- Stine H. Stensgaard
- Department of Obstetrics and Gynecology, Perinatal Research Unit, Birmingham, UK
| | - Karl Moeller Bek
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark, Birmingham, UK
| | - Khaled M.K. Ismail
- Birmingham Centre for Women and Children Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Academic Unit, Birmingham Women's NHS Foundation Trust, Birmingham, UK
- *Prof. Khaled M.K. Ismail, MSc, MD, PhD, FRCOG, Academic Unit, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham B15 2TG (UK), E-Mail
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Impact of levator trauma on pelvic floor muscle function. Int Urogynecol J 2013; 25:375-80. [PMID: 24085143 DOI: 10.1007/s00192-013-2226-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Levator trauma is common after vaginal delivery, either as macrotrauma, i.e., levator avulsion, or microtrauma, i.e., irreversible overdistension of the levator hiatus. The effect of microtrauma on muscle function is unknown. We tested the hypothesis that levator trauma is associated with reduced contractile function of the levator ani. METHODS Pregnant nulliparous women were recruited and seen before and after childbirth. All underwent an interview, a clinical examination including pelvic floor muscle (PFM) assessment using the Modified Oxford scale (MOS) [as an optional component] and translabial ultrasound. Sonographic and clinical parameters of PFM function were assessed before and after childbirth. RESULTS Out of 560 women, 446 returned at a median of 5 months after childbirth and 433 were suitable for analysis. There was a significant reduction in all measures of PFM function except for MOS. Change in MOS was associated with delivery mode [analysis of variance (ANOVA) P = 0.006). Forty-seven (15 %) vaginally parous women were diagnosed with levator avulsion, which was associated with a reduction in PFM contractility on sonographic parameters and MOS. However, only clinical assessment reached statistical significance. Sixty-five of 312 (21 %) women were diagnosed with microtrauma. We found no evidence of impairment in PFM contractility on ultrasound, but there was a statistically significant reduction in MOS. CONCLUSIONS Both levator avulsion (macrotrauma) and irreversible overdistension (microtrauma) are associated with reduced contractile function. This effect is more easily detected by palpation than by sonographic indices of levator function.
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Stuge B, Sætre K, Ingeborg Hoff B. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. ACTA ACUST UNITED AC 2013; 18:327-32. [DOI: 10.1016/j.math.2012.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/04/2012] [Accepted: 12/17/2012] [Indexed: 01/08/2023]
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37
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Whittaker J. Abdominal Ultrasound Imaging of Pelvic Floor Muscle Function in Individuals with Low Back Pain. J Man Manip Ther 2013. [DOI: 10.1179/106698104790825491] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Stafne SN, Salvesen KÅ, Romundstad PR, Torjusen IH, Mørkved S. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomised controlled trial. BJOG 2012; 119:1270-80. [DOI: 10.1111/j.1471-0528.2012.03426.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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39
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Aran T, Osmanagaoglu MA, Kart C, Guven S, Sahin M, Unsal MA. Failed labor induction in nulliparous women at term: the role of pelvic floor muscle strength. Int Urogynecol J 2012; 23:1105-10. [DOI: 10.1007/s00192-012-1754-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
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40
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High resolution magnetic resonance imaging of urethral anatomy in continent nulliparous pregnant women. Eur J Radiol 2011; 80:736-9. [DOI: 10.1016/j.ejrad.2010.08.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 08/23/2010] [Indexed: 11/20/2022]
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Hocaoglu Y, Roosen A, Herrmann K, Tritschler S, Stief C, Bauer RM. Real-time magnetic resonance imaging (MRI): anatomical changes during physiological voiding in men. BJU Int 2011; 109:234-9. [DOI: 10.1111/j.1464-410x.2011.10255.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Buckland-Nicks JA, Gillis M, Reimchen TE. Neural network detected in a presumed vestigial trait: ultrastructure of the salmonid adipose fin. Proc Biol Sci 2011; 279:553-63. [PMID: 21733904 DOI: 10.1098/rspb.2011.1009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A wide variety of rudimentary and apparently non-functional traits have persisted over extended evolutionary time. Recent evidence has shown that some of these traits may be maintained as a result of developmental constraints or neutral energetic cost, but for others their true function was not recognized. The adipose fin is small, fleshy, non-rayed and located between the dorsal and caudal fins on eight orders of basal teleosts and has traditionally been regarded as vestigial without clear function. We describe here the ultrastructure of the adipose fin and for the first time, to our knowledge, present evidence of extensive nervous tissue, as well as an unusual subdermal complex of interconnected astrocyte-like cells equipped with primary cilia. The fin contains neither adipose tissue nor fin rays. Many fusiform actinotrichia, comprising dense striated macrofibrils, support the free edge and connect with collagen cables that link the two sides. These results are consistent with a recent hypothesis that the adipose fin may act as a precaudal flow sensor, where its removal can be detrimental to swimming efficiency in turbulent water. Our findings provide insight to the broader themes of function versus constraints in evolutionary biology and may have significance for fisheries science, as the adipose fin is routinely removed from millions of salmonids each year.
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Affiliation(s)
- J A Buckland-Nicks
- Department of Biology, St Francis Xavier University, Antigonish, Nova Scotia, Canada.
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43
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Madill S, Tang A, Pontbriand-Drolet S, Dumoulin C. Comparison of two methods for measuring the pubococcygeal line from sagittal-plane magnetic resonance imaging. Neurourol Urodyn 2011; 30:1613-9. [DOI: 10.1002/nau.21079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/27/2011] [Indexed: 11/12/2022]
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Muctar S, Schmidt WU, Batzill W, Westphal J. [Functional anatomy of the female pelvic floor: interdisciplinary continence and pelvic floor surgery]. Urologe A 2011; 50:785-91. [PMID: 21691868 DOI: 10.1007/s00120-011-2605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Knowledge of functional anatomy is a prerequisite for the safe and targeted reconstructive therapy of incontinence and the prolapse syndrome of the female pelvic floor. We illustrate the interaction of muscles and connective tissue of the pelvic floor with anatomical illustrations and demonstrate their impact on the function of the urethra, bladder, vagina, uterus and rectum. Examples for the therapeutic rationale for a surgical reconstruction of the pelvic floor are defined and justified from their functional anatomy.
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Affiliation(s)
- S Muctar
- Rheinisches Kontinenz- und Beckenbodenzentrum, St. Josefshospital Uerdingen, Krefeld, Deutschland.
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Tague RG. Fusion of coccyx to sacrum in humans: prevalence, correlates, and effect on pelvic size, with obstetrical and evolutionary implications. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2011; 145:426-37. [PMID: 21541925 DOI: 10.1002/ajpa.21518] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 01/30/2011] [Indexed: 11/07/2022]
Abstract
Humans do not have a tail, but we have four rudimentary coccygeal vertebrae. This study considers several issues pertaining to fusion of the coccyx to the sacrum, including prevalence, sexual differences, effect on pelvic size, and obstetrical and evolutionary implications. Previous research on sacral-coccygeal fusion has reported: (1) lower prevalence in females than males, (2) prevalence increases with age, (3) range in prevalence among 13 samples from 0 to 72%, and (4) obstetrical complications. This study uses a sample of 2,354 American skeletons of known sex, age 20 years and older to ascertain prevalence of sacral-coccygeal fusion and to evaluate some of its correlates. Results show that the sexes do not differ in prevalence of sacral-coccygeal fusion for five of seven decades of life, but that prevalence does increase with advancing age-from 24 to 47% from the third to eighth decades of life in females. Pelvimetric analysis of 132 females shows that those with sacral-coccygeal fusion have a shorter posterior sagittal diameter of the outlet compared to those without fusion; more than half of those with sacral-coccygeal fusion have an obstetrically contracted posterior sagittal diameter. Shortening of the posterior sagittal diameter is important, because its conjoint occurrence with a narrow subpubic arch may result in an obstetrically inadequate outlet. This study concludes that sacral-coccygeal fusion is a principal contributor to the evolution of sexual dimorphism in sacral angulation, which is a determinant of the length of the posterior sagittal diameter of the outlet.
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Affiliation(s)
- Robert G Tague
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, 70803-4105, USA.
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Crotty K, Bartram CI, Pitkin J, Cairns MC, Taylor PC, Dorey G, Chatoor D. Investigation of optimal cues to instruction for pelvic floor muscle contraction: A pilot study using 2D ultrasound imaging in pre-menopausal, nulliparous, continent women. Neurourol Urodyn 2011; 30:1620-6. [DOI: 10.1002/nau.21083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 02/01/2011] [Indexed: 11/07/2022]
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Price N, Dawood R, Jackson SR. Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas 2010; 67:309-15. [PMID: 20828949 DOI: 10.1016/j.maturitas.2010.08.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 08/06/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
Urinary incontinence is a common problem among adults and conservative management is recommended as the first-line treatment. Physical therapies, particularly pelvic floor muscle exercise, are the mainstay of such conservative management. The purpose of this review is to summarise current literature and describe trends in the use of pelvic floor muscle exercise in the management of urinary incontinence in women. Our review confirms that pelvic floor muscle exercise is particularly beneficial in the treatment of urinary stress incontinence in females. Studies have shown up to 70% improvement in symptoms of stress incontinence following appropriately performed pelvic floor exercise. This improvement is evident across all age groups. There is evidence that women perform better with exercise regimes supervised by specialist physiotherapists or continence nurses, as opposed to unsupervised or leaflet-based care. There is evidence for the widespread recommendation that pelvic floor muscle exercise helps women with all types of urinary incontinence. However, the treatment is most beneficial in women with stress urinary incontinence alone, and who participate in a supervised pelvic floor muscle training programme for at least three months.
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Affiliation(s)
- Natalia Price
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK.
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Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A. Phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing-a dynamic MRI investigation in healthy females. Int Urogynecol J 2010; 22:61-8. [PMID: 20809211 DOI: 10.1007/s00192-010-1240-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/30/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS the aim of this pilot study was to demonstrate physiological movements of the muscular walls surrounding the abdominal cavity during breathing and coughing in healthy nulliparous women by means of real-time dynamic magnetic resonance imaging (MRI). METHODS eight volunteers underwent MRI measurements in a 1.5-T whole body MR-scanner. Coronal and sagittal slices were acquired simultaneously to assess respiratory-related cranio-caudal movement of diaphragm and pelvic floor (PF) and concomitant changes in horizontal abdominal diameter. RESULTS respective mean amplitudes of cranio-caudal movement of the right and left diaphragmatic cupolae were 15 ± 6 and 9 ± 7 mm during quiet breathing; 32 ± 15 and 28 ± 16 mm during forceful breathing; and 32 ± 13 and 28 ± 7 mm during coughing. Both diaphragm and PF moved caudally during inspiration and cranially during expiration. Abdominal diameter decreased in all eight women consistently during the expiration phase of breathing, and in five women during coughing. CONCLUSIONS in healthy women, real-time dynamic MRI demonstrates parallel cranio-caudal movement of the diaphragm and the PF during breathing and coughing and synchronous changes in abdominal wall diameter.
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Affiliation(s)
- Helena Talasz
- Department of Internal Medicine, Hochzirl Hospital, 6170 Zirl, Austria.
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Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010:CD005654. [PMID: 20091581 DOI: 10.1002/14651858.cd005654.pub2] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence. It is sometimes recommended for mixed and less commonly urge urinary incontinence. OBJECTIVES To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments. SEARCH STRATEGY The Cochrane Incontinence Group Specialised Trials Register (searched 18 February 2009) and the reference lists of relevant articles were searched. SELECTION CRITERIA Randomised or quasi-randomised trials in women with stress, urge or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm. DATA COLLECTION AND ANALYSIS Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook (Higgins 2008). Trials were subgrouped by diagnosis. Formal meta-analysis was not undertaken because of study heterogeneity. MAIN RESULTS Fourteen trials involving 836 women (435 PFMT, 401 controls) met the inclusion criteria; twelve trials (672) contributed data to the analysis. Many studies were at moderate to high risk of bias, based on the trial reports. There was considerable variation in interventions used, study populations, and outcome measures.Women who did PFMT were more likely to report they were cured or improved than women who did not. Women who did PFMT also reported better continence specific quality of life than women who did not. PFMT women also experienced fewer incontinence episodes per day and less leakage on short office-based pad test. Of the few adverse effects reported, none were serious. The trials in stress urinary incontinent women which suggested greater benefit recommended a longer training period than the one trial in women with detrusor overactivity (urge) incontinence. AUTHORS' CONCLUSIONS The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress, urge, or mixed, urinary incontinence. Statistical heterogeneity reflecting variation in incontinence type, training, and outcome measurement made interpretation difficult. The treatment effect seems greater in women with stress urinary incontinence alone, who participate in a supervised PFMT programme for at least three months, but these and other uncertainties require testing in further trials.
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Affiliation(s)
- Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, 7077 avenue du Parc, Montreal, Quebec, Canada, H3N 1X7
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Bø K, Mørkved S, Frawley H, Sherburn M. Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: A systematic review. Neurourol Urodyn 2009; 28:368-73. [PMID: 19191277 DOI: 10.1002/nau.20700] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Kari Bø
- Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway.
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