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Sheng Y, Carpenter JS, Ashton-Miller JA, Miller JM. Mechanisms of pelvic floor muscle training for managing urinary incontinence in women: a scoping review. BMC Womens Health 2022; 22:161. [PMID: 35562699 PMCID: PMC9103460 DOI: 10.1186/s12905-022-01742-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pelvic floor muscle training is recommended as first line treatment for urinary incontinence in women based on three proposed theorized mechanisms: 'Enhanced Pelvic Floor Muscle Strength,' 'Maximized Awareness of Timing,' and 'Strengthened Core Muscles'. The purpose of this scoping review was to systematically map evidence for and against theorized mechanisms through which pelvic floor muscle training interventions work to reduce urinary incontinence in women. METHODS The scoping review is based upon a comprehensive search of relevant literature published from 1990 to 2020 in PubMed, CINAHL, PsycINFO, ClinialTrials.gov, reference lists from review articles, and hand searches of articles by known researchers in the field. We included English-language, peer-reviewed articles on pelvic floor muscle training as an intervention for adult women if they provided empirical evidence to testing the theorized intervention mechanisms. Two independent reviewers screened articles for inclusion and extracted data to describe details of each study (author, year, country, design, sampling), measures of pelvic floor muscle strength and urinary incontinence, statistical analysis of linkage between changes in the measures, and pelvic floor muscle training regimens. Data were summarized to facilitate the integration of diverse evidence to draw conclusions on supporting or refuting the three proposed theorized mechanisms for managing urinary incontinence in women. RESULTS Of the 278 articles identified with the search, 13 (4.7%) met inclusion criteria. There was weak to no evidence for the mechanism of enhanced pelvic floor muscle strength, equivocal support for maximized awareness of timing, and no evidence for strengthened core muscles. CONCLUSIONS This review revealed extremely limited data supporting the proposed theorized mechanisms underlying pelvic floor muscle training programs to manage urinary incontinence in women. Such evidence is needed to help women and clinicians understand how, why and when a woman benefits from pelvic floor muscle training. Future studies should specifically state and report statistical analysis that relates the theorized mechanisms to the training outcomes observed.
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Affiliation(s)
- Ying Sheng
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA.
| | - Janet S Carpenter
- Indiana University School of Nursing, 600 Barnhill Dr., Indianapolis, IN, 46202, USA
| | - James A Ashton-Miller
- Department of Mechanical Engineering, 2350 Hayward, Ann Arbor, MI, 48109, USA
- Institute of Gerontology, University of Michigan, 300 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Janis M Miller
- Department of Health Behavior and Biological Science, School of Nursing, 426 N Ingalls St, Ann Arbor, MI, 48104, USA
- Department of Obstetrics and Gynecology, Medical School, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
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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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Schroeder R, de Mooij K, Groen L, Dik P, Kuijper C, Klijn A, de Jong T. Static and Dynamic Ultrasound Imaging to Visualize the Bladder, Bladder Neck, Urethra, and Pelvic Floor in Children with Daytime Incontinence. Front Pediatr 2017; 5:247. [PMID: 29209599 PMCID: PMC5702330 DOI: 10.3389/fped.2017.00247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Rogier Schroeder
- Paediatric Urology, Emma Children's Hospital, Amsterdam, Netherlands.,Paediatric Urology, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Keetje de Mooij
- Paediatric Urology, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Luitzen Groen
- Paediatric Urology, Emma Children's Hospital, Amsterdam, Netherlands
| | - Pieter Dik
- Paediatric Urology, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Caroline Kuijper
- Paediatric Urology, Emma Children's Hospital, Amsterdam, Netherlands
| | - Aart Klijn
- Paediatric Urology, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Tom de Jong
- Paediatric Urology, Emma Children's Hospital, Amsterdam, Netherlands.,Paediatric Urology, Wilhelmina Children's Hospital, Utrecht, Netherlands
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Kouba E, Newman B, Dairiki Shortliffe LM. Analysis of Kidney Ultrasound Dimensions by Body Habitus and Position. J Urol 2016; 196:943-9. [PMID: 26874315 DOI: 10.1016/j.juro.2016.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Renal dimensions are an important assessment of the genitourinary tract used to evaluate critical aspects of renal growth and development. Understanding the effect of patient position is important to use and interpret these parameters. In this prospective study we determined the effect of patient position and general body habitus on renal length and parenchymal area in children undergoing renal ultrasound. MATERIALS AND METHODS Between October 2010 and January 2011 children underwent renal ultrasound while prone and supine. Bilateral renal length and renal parenchymal area were measured. Pearson and Bland-Altman statistical analyses were used to examine correlations, measurement bias and the degree of agreement between methods. RESULTS Renal length measurements in both positions were complete for 201 right and 196 left kidneys. Parenchymal area measurements were complete for both kidneys in 177 children. When compared individually, supine and prone measures of renal length and parenchymal area highly correlated on Pearson analysis (greater than 0.96 and greater than 0.89, respectively). When compared by method, Bland-Altman analyses of differences vs means showed greater than 50% variance, representing wide limits of agreement with poor interrelation. Neither persistent systematic bias nor body habitus influenced results. CONCLUSIONS While Pearson analysis showed high correlation for supine and prone renal measurements, Bland-Altman analysis of renal length and parenchymal area demonstrated wide limits of agreement, not allowing interchangeable use of prone and supine measurements. As such, renal ultrasound should specify standardized positions and benchmarks. These results provide guidance to standardize renal ultrasound measurements when renal size is used as an indicator of kidney health.
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Affiliation(s)
- Erik Kouba
- Department of Pathology, University of Indiana, Indianapolis, Indiana
| | - Beverley Newman
- Department of Radiology, Stanford University, Stanford, California
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Hennemann J, Kennes LN, Maass N, Najjari L. Evaluation of established and new reference lines for the standardization of transperineal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:610-616. [PMID: 24481671 DOI: 10.1002/uog.13318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/22/2013] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine the performance of a new reference line for the assessment of pelvic organ descent by transperineal ultrasound. METHODS We compared our newly proposed reference line, between two hyperechoic contours of the symphysis pubis (Line 3), with the horizontal reference line proposed by Dietz and Wilson (Line 1) and the central pubic line proposed by Schaer et al. (Line 2). Ultrasound volumes of 94 women obtained in routine clinical practice were analyzed. The perpendicular distance from the reference lines to the internal sphincter and the most dependent part of the bladder base was measured for volumes obtained at rest, on pelvic floor muscle contraction, on Valsalva maneuver and during coughing. Measurements were repeated 4 months later by the same examiner. Rates of assessment were calculated, and intrarater reliability was evaluated using Bland-Altman plots and intraclass correlation coefficients. RESULTS Line 2 had to be excluded from reliability analysis because of an assessment rate of only 12%, whereas Lines 1 and 3 could be assessed in 100% of volumes. The intrarater repeatability of Lines 1 and 3 was shown to be very similar. CONCLUSION In this comparison of three potential reference lines for the assessment of pelvic organ descent by transperineal ultrasound, the central pubic line was shown to be inferior owing to poor visibility in our volumes. Inter-rater reliability analysis and validation studies are required to confirm our results.
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Affiliation(s)
- J Hennemann
- Department of Gynaecology and Obstetrics, University Hospital Aachen, Aachen, Germany
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Cruz DSLDC, D’Ancona CAL, Baracat J, Alves MAD, Cartapatti M, Damião R. Parameters of two-dimensional perineal ultrasonography for evaluation of urinary incontinence after Radical Prostatectomy. Int Braz J Urol 2014; 40:596-604. [DOI: 10.1590/s1677-5538.ibju.2014.05.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/04/2014] [Indexed: 11/22/2022] Open
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Majida M, Braekken IH, Umek W, Bø K, Saltyte Benth J, Ellstrøm Engh M. Interobserver repeatability of three- and four-dimensional transperineal ultrasound assessment of pelvic floor muscle anatomy and function. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:567-573. [PMID: 19402120 DOI: 10.1002/uog.6351] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the interobserver repeatability of measurement of the pubovisceral muscle and levator hiatus, and the position of related organs, during rest, muscle contraction and Valsalva maneuver using three- and four-dimensional (3D and 4D) transperineal ultrasound. METHODS Seventeen women were included in the study. The position and dimensions of the pubovisceral muscle and levator hiatus in patients at rest and during contraction and Valsalva were determined from stored 3D and 4D ultrasound volumes. Analyses were conducted offline by two observers blinded to the clinical data and to each others' measurements. RESULTS Measurements of levator hiatal dimensions at rest demonstrated intraclass correlation coefficient (ICC) values of 0.92 to 0.96. The ICC values for pubovisceral muscle thickness at rest varied between good and very good (ICC, 0.61-0.93), regardless of plane. During contraction, the ICC values for all measured parameters were very good, varying between 0.61 and 0.92. Measurement of the transverse diameter of the levator hiatus during the Valsalva maneuver showed good reliability (ICC, 0.86), but assessment of the anterior and posterior borders of the levator hiatus was only possible in 29% of cases. CONCLUSIONS 3D and 4D transperineal ultrasound measurement of the pubovisceral muscle and levator hiatus is reliable in women with no or minor symptoms of prolapse at rest and during contraction. The technique for recording during the Valsalva maneuver requires improvement if it is to be useful in the diagnosis of pelvic organ prolapse.
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Affiliation(s)
- M Majida
- Akershus University Hospital, Department of Obstetrics and Gynaecology, Lørenskog, Oslo, Norway.
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Braekken IH, Majida M, Ellstrøm-Engh M, Dietz HP, Umek W, Bø K. Test–retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function. Int Urogynecol J 2007; 19:227-35. [PMID: 17599234 DOI: 10.1007/s00192-007-0408-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
The aims of the present study were to evaluate test-retest intra-observer repeatability of ultrasound measurement of the morphology and function of the pelvic floor muscles (PFMs). Seventeen subjects were tested twice. Two-, three- and four- dimensional ultrasound recorded cough, huff, muscle morphology and PFM contraction, respectively. Analyses were conducted offline. Measurements of levator hiatal dimensions demonstrated intra-class correlation coefficient (ICC) values of 0.61, 0.72, 0.86 and 0.92, for the anterior-posterior dimension, transverse dimension, resting area and narrowing during contraction, respectively. Muscle thickness showed variable reliability. ICC values for measurement of the position of the bladder neck were 0.86 and 0.82 at rest, in the vertical and horizontal direction. Displacement of the bladder neck during contraction, huff and cough demonstrated ICC values of 0.56, 0.59 and 0.51, respectively. Perineal ultrasound is a reliable method for measuring most of the tested parameters of morphology and function of the PFMs.
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Affiliation(s)
- Ingeborg Hoff Braekken
- Department of Sports Medicine, Norwegian School of Sport Sciences, P.O. Box 4014, Ulleval Stadion, 0806 Oslo, Norway.
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