Test-retest reliability of the different dynamometric variables used to evaluate pelvic floor musculature during the menstrual cycle

Is the Elite Female Athlete's Pelvic Floor Stronger?

Background: Exercise can stress the pelvic floor muscles (PFMs). This study sought to assess the strength of the PFMs according to the level of physical exercise. Methods: An analytical observational study was carried out using digital palpation and dynamometry measurements to assess PF strength. Healthy nulliparous women were stratified according to physical exercise (physically active and sedentary) and level of physical exercise (elite, amateur, and sedentary). Results: Fifty-four women were analyzed, with a mean age of 25.64 (5.33) years and a BMI of 21.41 (2.96) kg/m2. Differences in the passive force and strength were observed between both groups of women (p < 0.05), and the strength was around two times higher in physically active women (p < 0.05). The strength was similar between elite female athletes and sedentary women (p > 0.05), but statistical differences were found with amateurs (p < 0.05). The PFM strength (p = 0.019) of elite female athletes (0.34 N) was almost half that of amateurs (0.63 N) and twice as strong as that of sedentary women (0.20 N). However, these differences were not significant using digital palpation (p = 0.398). Conclusions: Women who exercise generally have greater PFM strength than women who do not exercise. Physical exercise could strengthen the PFM; however, the high intensity demanded by high-level sports does not seem to proportionally increase the strength of the PFMs.

Acute Effect of Heavy Weightlifting on the Pelvic Floor Muscles in Strength-Trained Women: An Experimental Crossover Study

INTRODUCTION/PURPOSE

Heavy lifting may produce strain on the pelvic floor muscles (PFM) due to high increases in intra-abdominal pressure, but knowledge of the impact of weightlifting on the PFM is lacking. Therefore, this study aimed to investigate acute effects of heavy weightlifting on the PFM in strength-trained women and whether general strength in whole-body exercises correlated to PFM strength.

METHODS

Forty-seven nulliparous women between 18 and 35 yr who regularly performed weightlifting and were able to lift their own body weight × 1.2 in back squat and 1.5 in deadlift were included in this experimental crossover study. They participated in baseline evaluations (questionnaire/measurements of background characteristics and pelvic floor disorders, one-repetition maximum (1RM) tests in back squat and deadlift) and one test day where they were randomized to start with 60 min of weightlifting (four sets of four repetitions at 75%-85% of 1RM in back squat and deadlift) or seated rest of 60 min. Vaginal pressure measurements of PFM resting pressure, strength, and endurance and surface electromyography measurements of PFM resting activity were performed before/after weightlifting and rest.

RESULTS

No statistically significant differences were found when comparing the change in PFM resting pressure, strength, endurance, and resting activity after heavy weightlifting and rest. There were no statistically significant correlations between PFM strength and maximum (1RM) or relative strength (1RM/bodyweight) in either back squat or deadlift.

CONCLUSIONS

Our results imply that heavy weightlifting is well tolerated by the PFM in short term among young, nulliparous, and strength-trained women. Strength in whole-body exercises was not correlated to PFM strength.

The state of pelvic floor muscle dynamometry: A scoping review

AIMS

To discuss the advantages and limitation of the different pelvic floor muscle (PFM) dynamometers available, both in research and industry, and to present the extent of variation between them in terms of structure, functioning, psychometric properties, and assessment procedures.

METHODS

We identified relevant studies from four databases (MEDLINE, Compendex, Web of Science, and Derwent Innovations Index) up to December 2020 using terms related to dynamometry and PFM. In addition, we conducted a hand search of the bibliographies of all relevant reports. Peer-reviewed papers, conference proceedings, patents and user's manuals for commercial dynamometers were included and assessed by two independent reviewers.

RESULTS

One hundred and one records were included and 23 PFM dynamometers from 15 research groups were identified. From these, 20 were considered as clinical dynamometers (meant for research settings) and three as personal dynamometers (developed by the industry). Overall, significant heterogeneity was found in their structure and functioning, which limits development of normative data for PFM force in women. Further research is needed to assess the psychometric properties of PFM dynamometers and to standardize assessment procedures.

CONCLUSION

This review points up to the heterogeneity of existing dynamometers and methods of assessing PFM function. It highlights the need to better document their design and assessment protocol methods. Additionally, this review recommends standards for new dynamometers to allow the establishment of normalized data.

Subsequent Use of a Pressure Sensor to Record Intra-Abdominal Pressure After Maximum Vaginal Closure Force in a Clinical Trial

Pelvic floor disorders are caused by weakening or damage to the tissues lining the bottom of the abdominal cavity. These disorders affect nearly 1 in every 4 women in the United States and symptoms that drastically diminish a patient’s quality of life. Vaginal closure force is a good measure of pelvic health, but current vaginal dynamometers were not designed for the rigors of hospital reprocessing, often failing due to sensor degradation through repeated sterilization processes. In order to obtain measurements of vaginal closure force in a large study, we designed a vaginal dynamometer that utilizes a removable intra-abdominal sensor already in production for the study. The sensor’s existing data acquisition system was modified to transmit to a tablet allowing the user to view data in real-time. The new speculum design allowed a single sensor to measure vaginal closure force before being used to collect intra-abdominal pressure data in the same study visit. The measurements taken with the new speculum were similar to measurements taken with a previously reported vaginal dynamometer.

Review of pelvic and perineal neuromuscular fatigue: Evaluation and impact on therapeutic strategies

BACKGROUND

Pelvic floor fatigue is known by its clinical consequences (fecal incontinence, stress urinary incontinence, pelvic organ prolapse), but there are still few studies on the subject.

OBJECTIVE

This article presents an overview of the current knowledge of pelvic and perineal fatigue, focusing on its assessment and consequences in terms of evaluation and therapeutic strategies, to propose an evaluation that could be routinely performed.

METHODS

We performed a systematic review of the literature in MEDLINE via PubMed and Cochrane Library databases by using the keywords pelvic floor, muscular fatigue, physiopathology, stress urinary incontinence, pelvic organ prolapse, fecal incontinence, physical activity, and pelvic rehabilitation. We included reports of systematic reviews and retrospective and prospective studies on adult humans and animals in English or French published up to April 2018 with no restriction on start date.

RESULTS

We selected 59 articles by keyword search, 18 by hand-search and 3 specific guidelines (including the 2009 International Continence Society recommendations); finally 45 articles were included; 14 are described in the Results section (2 reviews of 6 and 20 studies, and 12 prospective observational or cross-over studies of 5 to 317 patients including 1 of animals). Perineal fatigue can be assessed by direct assessment, electromyography and spectral analysis and during urodynamics. Because pelvic floor fatigue assessments are not evaluated routinely, this fatigability is not always identified and is often falsely considered an exclusive pelvic floor weakness, as suggested by some rehabilitation methods that also weaken the pelvic floor instead of enhancing it.

CONCLUSION

Pelvic floor fatigue is not evaluated enough on a routine basis and the assessment is heterogeneous. A better knowledge of pelvic floor fatigue by standardized routine evaluation could lead to targeted therapeutic strategies.