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Ben Ami N, Feldman R, Dar G. Verbal Instruction for Pelvic Floor Muscle Contraction among Healthy Young Males. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12031. [PMID: 36231333 PMCID: PMC9566287 DOI: 10.3390/ijerph191912031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Teaching Pelvic Floor Muscle (PFM) contraction is a challenging task for clinicians and patients, as these muscles cannot be directly visualized. Thus, this study's objective is to compare the effectiveness of six verbal instructions for contracting the PFM among young men, as observed with transabdominal ultrasound imaging. Thirty-five male physiotherapy students, mean age 25.9 ± 1.9 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, supra-pubically, and angled 15-30° from the vertical plane. During crook lying, participants received six verbal instructions for contracting the PFM, with bladder base displacement and endurance evaluated. Following the instructions, "squeeze your anus", "shorten the penis", and "elevate the scrotum", over 91% of the participants performed a cranial (upward) bladder base displacement. During instruction six, "draw in", which involves breathing, the PFM, and the transversus abdominis, only 25% performed cranial bladder base displacement (p < 0.001), and the endurance was the lowest (p < 0.001). Our findings suggest that several simple verbal instructions can be used for teaching PFM contraction to young males. Moreover, two instructions should be avoided: "draw in" and the general instruction "squeeze your PFM", as they did not produce effective elevation of the bladder base.
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Affiliation(s)
- Noa Ben Ami
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel
| | - Ron Feldman
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel
| | - Gali Dar
- Department of Physical Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
- Ribstein Center for Research and Sports Medicine, Wingate Institute, Netanya 4290200, Israel
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Does the Contractile Capability of Pelvic Floor Muscles Improve with Knowledge Acquisition and Verbal Instructions in Healthy Women? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159308. [PMID: 35954665 PMCID: PMC9368630 DOI: 10.3390/ijerph19159308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/10/2022]
Abstract
Seventy percent of women with pelvic floor dysfunctions (PFDs) are estimated to present deficient consciousness of their pelvic floor muscles (PFMs) and poor ability to contract them. Improving the proprioception of PFMs, defined as the capacity to know the status and position of each body part, and adequately contracting them could be a protective factor to prevent the appearance of PFDs in the general female population. This study aimed to identify the effectiveness of educational interventions and verbal instructions on how to contract and exercise the PFMs to improve the proprioception of the PFMs in women. A systematic search of studies published in the last 20 years until March 2022 was conducted in the PubMed, Cochrane Library, Web of Science, Scopus, PEDro, Lilacs, and Dialnet databases. A meta-analysis could not be performed due to the heterogeneity in the types of studies and included populations. This review followed the PRISMA guidelines for the design, search, and reporting of studies. The methodological quality was analysed via the PEDro and the Newcastle–Ottawa scales in the case of randomised clinical trials and non-randomised studies, respectively, while the quality of evidence was determined using the SIGN grading system for evidence-based guidelines. Descriptive and experimental studies published in English, Spanish, or Portuguese that evaluated the contractile capability of the PFMs in healthy women or women without a previous diagnosis of PFD were included. Seven articles that included a total of 2507 women were found, three of which were clinical trials with PEDro scores between 5 and 9 points out of 10 and four of which were non-randomised studies with NOS scores between 6 and 8 points out of 10. The outcomes were measured through vaginal palpation, visual observation, questionnaires for PFD symptoms, and self-perception reports. This review discriminated between two types of intervention, educational programmes and verbal instructions, and evaluated the changes observed in PFM strength and knowledgeability and the symptoms of PFDs. The findings showed that educational interventions and verbal instructions improve the proprioception of PFMs in women of all ages that are healthy or without a previous diagnosis of PFDs as well as their knowledge about the pelvic floor, healthy lifestyle habits, and symptoms that are potentially indicative of PFDs. Further high-quality randomised clinical trials are warranted to draw definitive conclusions about the effectiveness of educational interventions to improve the proprioception of the PFMs in women considered healthy or with mild symptoms that may be indicative of PFDs.
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Charlanes A, Chesnel C, Jousse M, Le Breton F, Sheikh Ismael S, Amarenco G, Hentzen C. Verbal instruction to obtain voluntary pelvic floor muscle contraction: Acceptability, and understanding. Prog Urol 2021; 31:231-237. [PMID: 33414018 DOI: 10.1016/j.purol.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to describe verbal instructions used to obtain a voluntary pelvic floor muscle contraction and to evaluate their understanding and acceptability. METHODS This prospective study led in two phases. A questionnaire was submitted to experts to collect the most frequently used instructions to obtain a PFMC. Then a questionnaire was submitted to subjects in order to: estimate the pelvic floor anatomical knowledge; estimate understanding and acceptability of these instructions; select the best instruction. RESULTS First phase: 46 experts proposed 356 instructions. Forty-four percent were functional instructions ("hold a gas"), 40% anatomical ("squeeze your anus") and 16% allied both. Fifteen instructions for the women and 11 for the men were selected. Second phase: 33 subjects completed the questionnaire. More than 75% had correct answers for anatomical knowledge. The instructions judged by the subjects as the most adapted to obtain a PFMC were: "contract the anus", "do as if you wanted to hold a strong desire to void". The items including "perineum" or "vagina" were less understood. CONCLUSIONS The more understandable and acceptable instruction to assess the PFMC is the association of two simple instructions: one anatomical and one functional. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Charlanes
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Chesnel
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Jousse
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France; Département de médecine physique et de réadaptation, GH Saint-Louis-Lariboisière-F.-Widal, Paris-Diderot university, AP-HP, Paris, France
| | - F Le Breton
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - S Sheikh Ismael
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - G Amarenco
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Hentzen
- GREEN Groupe de recherche clinique en neuro-urologie, GRC 001, Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France.
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Caagbay D, Raynes-Greenow C, Dangal G, Mc Geechan K, Black KI. Impact of an informational flipchart on lifestyle advice for Nepali women with a pelvic organ prolapse: a randomized controlled trial. Int Urogynecol J 2020; 31:1223-1230. [PMID: 32006071 DOI: 10.1007/s00192-020-04228-1] [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: 11/23/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor muscle training (PFMT) and lifestyle advice are effective at improving the symptoms and severity of pelvic organ prolapse (POP) in a range of populations; however, the impact of these interventions in Nepali women is unknown. We aimed to evaluate the impact of an informational flipchart on PFMT and lifestyle advice on the quality of life (QOL) for Nepali women with a POP. METHODS This prospective randomized controlled trial recruited 140 women with a stage I-III POP from Kathmandu Valley. The intervention group were instructed on PFMT and lifestyle advice through an informational flipchart and the control group were provided usual care. The primary outcome measure was the Prolapse Quality of Life questionnaire (P-QOL) and was completed at baseline, 6 weeks, 12 weeks and 6 months. The secondary outcome measure was the Pelvic Organ Prolapse Quantification (POP-Q) system and Modified Oxford Scale (MOS) assessed by clinical examination at baseline and 6 months. Differences in mean P-QOL scores for each domain were evaluated using analysis of covariance. RESULTS Compared with usual care, the women in the informational flipchart group experienced significant improvement in six of the nine P-QOL domains and for the prolapse, bladder and bowel symptoms. Only a small percentage (20%) of women were able to attend the 6-month clinical assessment so we were unable to assess the secondary outcomes. CONCLUSIONS A one-time intervention of an informational flipchart on PFMT and lifestyle advice is effective at improving QOL and symptoms for Nepali women with a stage I-III POP.
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Affiliation(s)
- Delena Caagbay
- Discipline of Obstetrics and Gynaecology and Neonatology, The University of Sydney, Sydney, Australia.
| | | | - Ganesh Dangal
- Department of Obstetrics and Gynaecology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - Kevin Mc Geechan
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten I Black
- Discipline of Obstetrics and Gynaecology and Neonatology, The University of Sydney, Sydney, Australia
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Moser H, Luginbuehl H, Baeyens JP, Radlinger L. Reliability and validity of pelvic floor muscle displacement measurements during voluntary contractions. Int Urogynecol J 2019; 30:2093-2100. [PMID: 30949732 DOI: 10.1007/s00192-019-03932-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/13/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Understanding the functioning of pelvic floor muscles (PFM) is crucial in female PFM rehabilitation. The aim of this study was to determine the intra-session retest reliability and validity to evaluate the quantity of PFM displacement. METHODS This cross-sectional observational study examined the PFM displacement of 17 young healthy nulliparous women in the midsagittal plane. Three maximal voluntary contractions (MVCs) and five fast voluntary contractions (FVCs) were simultaneously examined with an electromagnetic tracking system (ETS) and transabdominal ultrasound (TAUS) and expressed in millimeters (mean, SD). To evaluate reliability and validity, the analysis of variance, intraclass coefficient (2,1), standard error of measurement (SEM), and minimal detectable difference (MDD) were calculated. RESULTS Maximal voluntary contractions and FVCs in supine position measured by an ETS (TAUS) showed a displacement of MVC: 3.5 ± 1.9 mm (7.8 ± 4.5 mm), FVC: 3.5 ± 2.4 mm (7.6 ± 5.3 mm), and during standing of MVC: 5.2 ± 1.6 mm (9.4 ± 3.8 mm) and FVC: 4.8 ± 2.5 mm (9.7 ± 4.1 mm). Intraclass correlation for the ETS (TAUS) measurement varied between 0.79 and 0.89 (0.61 and 0.74), SEM 0.52 and 1.03 mm (1.54 and 3.2 mm), and MDD 1.54 and 3.2 mm (6.64 and 7.53 mm). The correlation between an ETS and TAUS varied between 0.53 and 0.67. CONCLUSIONS For MVC and FVC, ETS measurements are highly reliable and TAUS measurements are moderately reliable for both contraction types. The correlation between the TAUS and ETS measurements is moderate. An ETS seems to be a reliable and valid measurement tool for evaluating PFM displacement during voluntary contractions. In future studies, the reproducibility and validity of ETS measurements need to be investigated in impact activities.
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Affiliation(s)
- Helene Moser
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland.
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Helena Luginbuehl
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
| | - Jean-Pierre Baeyens
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenz Radlinger
- Department of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland
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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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Mercier J, Tang A, Morin M, Khalifé S, Lemieux MC, Reichetzer B, Dumoulin C. Test-retest reliability of clitoral blood flow measurements using color Doppler ultrasonography at rest and after a pelvic floor contraction task in healthy adult women. Neurourol Urodyn 2018; 37:2249-2256. [DOI: 10.1002/nau.23582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/04/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Joanie Mercier
- School of Rehabilitation; Faculty of Medicine; University of Montreal; Research Centre of the Institut Universitaire de Gériatrie de Montréal; Montreal Canada
| | - An Tang
- Department of Radiology; Radio-Oncology and Nuclear Medecine; Centre hospitalier de l'Université de Montréal; Montreal Canada
| | - Mélanie Morin
- Faculty of Medicine; School of Rehabilitation; University of Sherbrooke; Research Centre of the Centre hospitalier universitaire de Sherbrooke; Sherbrooke Canada
| | - Samir Khalifé
- Department of Obstetrics and Gynecology; Sir Mortimer B. Davis-Jewish General Hospital; McGill University; Montreal Quebec Canada
| | - Marie-Claude Lemieux
- Department of Obstetrics and Gynecology; Maisonneuve-Rosemont Hospital; Montreal Canada
| | - Barbara Reichetzer
- Department of Obstetrics and Gynecology; Centre hospitalier de l'Université de Montréal; Montreal Canada
| | - Chantale Dumoulin
- Faculty of Medicine; School of Rehabilitation; University of Montreal; Research Centre of the Institut Universitaire de Gériatrie de Montréal; Montreal Canada
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Fradet S, Morin M, Kruger J, Dumoulin C. Pelvic Floor Morphometric Differences in Elderly Women with or without Urinary Incontinence. Physiother Can 2018; 70:49-56. [PMID: 29434418 DOI: 10.3138/ptc.2016-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but UI pathophysiology, specifically in elderly women, remains unclear. A better understanding of morphometric differences between continent and urinary incontinent elderly women is needed to improve the effectiveness of conservative treatment approaches. We hypothesized that morphometric differences in the pelvic floor muscles (PFM) among elderly women with and without UI could be observed using three- and four-dimensional (3D/4D) transperineal ultrasound (TPU) imaging. Method: A total of 40 elderly women (20 women with and 20 women without UI), with a mean age of 67.10 (SD 4.94) years, participated in the study. This was a case-control study in which TPU images were taken under three conditions: rest, maximal voluntary contraction (MVC), and Valsalva. Independent t-tests were conducted to compare measurements between the groups. Results: The study revealed statistically significant differences between the groups. At rest, the levator hiatal area and transverse diameter were bigger, and the PFM position was lower in the incontinent group. During MVC, all axial plane parameters were bigger in the incontinent group. In the sagittal plane, PFM position was again lower in the incontinent group. During Valsalva, the anorectal angle was wider in the women with incontinence. Conclusion: PFM morphometric differences were present and were observed using 3D/4D TPU imaging in elderly women with and without UI.
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Affiliation(s)
- Sarah Fradet
- Research Centre of the Institut Universitaire de Gériatrie de Montréal.,School of Rehabilitation, University of Montreal, Montreal
| | - Mélanie Morin
- Research Centre of the Centre Hospitalier de Sherbrooke.,School of Rehabilitation, University of Sherbrooke, Sherbrooke, Que
| | - Jennifer Kruger
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Chantale Dumoulin
- Research Centre of the Institut Universitaire de Gériatrie de Montréal.,School of Rehabilitation, University of Montreal, Montreal
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Flury N, Koenig I, Radlinger L. Crosstalk considerations in studies evaluating pelvic floor muscles using surface electromyography in women: a scoping review. Arch Gynecol Obstet 2017; 295:799-809. [PMID: 28176015 DOI: 10.1007/s00404-017-4300-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/13/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Surface electromyography (sEMG) using intravaginal probes is of widespread use for assessing pelvic floor muscles (PFM) activity in women. Although considered as a reliable method, its validity has been called into question due to the presence of a phenomenon called crosstalk. Crosstalk is described as the recording of sEMG activity originating from neighboring muscles rather than coming exclusively from the muscles being investigated. The purpose of this review was to provide an overview of existing literature about crosstalk during intravaginal surface electromyographic recordings. METHODS A scoping review was performed according to the Arksey and O'Malley framework. An electronic search was conducted on six relevant databases. Additionally, authors were directly contacted to identify grey literature. Data extraction consisted of descriptive numeric analysis as well as thematic analysis, which were conducted by two independent reviewers. RESULTS Forty-nine references written by 34 authors coming from 13 different countries constitute the body of evidence of the present review. Eight main themes have been identified through the thematic analysis. The included material varies greatly in terms of methodology, approach to the crosstalk problem and depth of analysis. CONCLUSIONS A gap in knowledge affecting the validity of the current sEMG investigation methods was identified. Literature addressing the crosstalk problem is scarce and often flawed. Definitive conclusions are regularly drawn from an insufficient basis of evidence. Further research is, therefore, deeply necessary, although it remains unclear whether this issue can be solved at all with current technology.
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Affiliation(s)
- Noémie Flury
- Bern University of Applied Sciences, Bern, Switzerland
| | - Irene Koenig
- Bern University of Applied Sciences, Bern, Switzerland.
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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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Botelho S, Pereira LC, Marques J, Lanza AH, Amorim CF, Palma P, Riccetto C. Is there correlation between electromyography and digital palpation as means of measuring pelvic floor muscle contractility in nulliparous, pregnant, and postpartum women? Neurourol Urodyn 2012; 32:420-3. [PMID: 23023961 DOI: 10.1002/nau.22321] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 08/28/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Simone Botelho
- Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil.
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