Pelvic muscle exercise effect on pelvic muscle performance in women

The aim of this study was to compare pelvic muscle (PM) characteristics (strength, endurance and contractability) before and after 12 weeks of pelvic muscle exercises in two groups of older women: the first composed of women with genuine stress incontinence, and the second made up of women with no symptoms of urinary incontinence or pelvic organ prolapse. This research also investigated the extent to which PM pressure and health-related characteristics could help discriminate between women with and without a clinical sign of PM dysfunction. Within a framework of skeletal muscle fitness, outcome measures were defined and compared. There was no significant difference in the baseline (P = 0.09) and post-PME (P = 0.63) strength, endurance and contractability of the two groups of women. The two groups did differ significantly on change scores (P = 0.05) following PME. A greater improvement in strength for women without a clinical sign of dysfunction was demonstrated. There was a probability of 91% that those with a history of gynecological surgery belonged to the group of women with SUI.

Continence for women: evidence-based practice

Approximately 20% of women ages 25-64 years experience urinary incontinence. The symptoms increase during perimenopause, when 31% of women report that they experience incontinent episodes at least once per month. Bladder training and pelvic muscle exercise are the recommended initial treatment and can be taught effectively in the ambulatory care setting. Bladder training enables women to accommodate greater volumes of urine and extend between-voiding intervals. Pelvic muscle exercise increases muscle strength and reduces unwanted urine leakage. Accumulated research results provide evidence-based guidelines for nursing practice. The Association of Women's Health, Obstetric and Neonatal Nurses has identified continence for women as the focus of its third research utilization project. This article presents the rationale, evidence base, and educational strategies compiled by the Research Utilization 3 Nurse Scientist Team. Nurses can enable women to incorporate these noninvasive techniques into self-care.

Using a relational database to support nursing research

Designing, implementing, and maintaining a relational database for a complex, longitudinal clinical research project can be the key to the success of a research project. Related issues of data entry, accuracy, confidentiality, security, data analysis, and evaluation of research activities are among the considerations that must be addressed. Our experience with designing a system that was effective and user-friendly to manage the data collected during a 6-year, National Institutes of Health-funded, nursing research project is highlighted. Nurses and other healthcare providers may find our experience with a relational database helpful and applicable to similar clinical research projects.

Dietary caffeine, fluid intake and urinary incontinence in older rural women

Forty-one women completed the first phase (self-monitoring) of the Behavioral Management for Continence (BMC) intervention, while working with a nurse during home visits to reduce involuntary urine loss as part of the parent study involving older, rural women living at home. A decrease in dietary caffeine intake and an increase in fluid intake were most frequently recommended. The relationship between a decrease in the amount of dietary caffeine consumed and fewer daytime episodes of involuntary urine loss approached significance -P = 0.0744- whereas an increase in the average amount of fluid intake was significantly related to an increase in the average volume of urine voided -P = 0.0479- and not to involuntary urine loss.

Current status of research on pelvic muscle strengthening techniques

In the past 15 years, research on the effect of pelvic muscle exercise on urinary stress incontinence has contributed substantially to the understanding of the function of the pelvic muscles and the role of pelvic muscle exercise in management of stress urinary incontinence. This literature review addresses pelvic muscle function, pelvic muscle exercise, pelvic muscle exercise training protocols and training aids, changes that result from pelvic muscle exercise, and long-term outcomes of pelvic muscle exercise. Emphasis is placed on results or research that may be used by the clinician with women who experience stress urinary incontinence.

Differences by race in the decline of health over time

Previous research on race differences in health, we believe, has failed to take into account the initial state of health of the respondents. Other research has demonstrated that elders in poor health are more likely to experience a change in their health over time. It is unclear if the greater probability of decline in health observed among African Americans is a result of being more likely to begin such observations in health states that are worse than those for Whites. This investigation examines declines in health over a 30-month period in a sample of African American and White elders who began the study in similar "good health." Findings support the supposition that African Americans are more likely to report a decline in their health, regardless of the health measure used. Differences by race in the decline of health appear to be a consequence of economic and educational discrepancies between the two groups.

Continence for women: evidence-based practice

Approximately 20% of women ages 25-64 years experience urinary incontinence. The symptoms increase during perimenopause, when 31% of women report that they experience incontinent episodes at least once per month. Bladder training and pelvic muscle exercise are the recommended initial treatment and can be taught effectively in the ambulatory care setting. Bladder training enables women to accommodate greater volumes of urine and extend between-voiding intervals. Pelvic muscle exercise increases muscle strength and reduces unwanted urine leakage. Accumulated research results provide evidence-based guidelines for nursing practice. The Association of Women's Health, Obstetric, and Neonatal Nurses has identified continence for women as the focus of its third research utilization project. This article presents the rationale, evidence base, and educational strategies compiled by the Research Utilization 3 Nurse Scientist Team. Nurses can enable women to incorporate these noninvasive techniques into self-care.

Race differences in the health of elders who live alone

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Behavioral management for bladder control: response in selected rural residential care homes

Urinary incontinence is a problem for elders in many settings, including rural residential care homes (RCHs). Behavioral techniques for the management of urinary incontinence have been successful with community-dwelling and nursing home populations. A study was undertaken to evaluate the feasibility of implementing bladder diaries and bladder training to assist RCH residents with bladder control. These techniques were found not to be successful in selected rural RCHs. The characteristics of rural RCHs are explored, and the impediments and incentives to the use of behavioral management techniques for urinary incontinence in these settings are examined.

Pelvic muscles during rest: responses to pelvic muscle exercise

The purpose of the research was to study pelvic muscle changes in the resting phase between voluntary contractions (during pelvic muscle assessment) and in response to pelvic muscle exercise (PME) through secondary analysis of data. The sample consisted of healthy women (N = 38) aged 35 to 54. Analysis of variance showed a significant difference in resting pressure within each assessment (F = 2.92, p < .04). A significant difference in resting pressures within subjects was found (F = 3.54, p < .02). Within-subject variance suggests exercises performed without a warmup may result in incomplete relaxation prior to contraction. Significant change between baseline and Level 1 of the graded PME program suggests slow relaxation of untrained muscles. Increases in resting pressure at Levels 3 and 4 may be a more accurate reflection of muscle hypertrophy. The results of this research indicate that care should be taken in establishing the point from which changes during contractions are measured. It is recommended that the resting pressure be used. Exercise continued for more than 3 or 4 weeks accounts for nearly all strength gains and explains the increases in resting pressure at PME Levels 3 and 4.

Validation of surface EMG as a measure of intravaginal and intra-abdominal activity: implications for biofeedback-assisted Kegel exercises

This study validates surface EMG as a measure of pelvic muscle and abdominal activity by showing its high correlation to internal pressure data. Using standardized scores, between-subjects correlation of perineal EMG and intravaginal pressure was r = .75, and the correlation of abdominal EMG and intra-abdominal pressure was r = .72. Discriminant validity was also demonstrated by showing low correlation between standardized abdominal and perineal EMG measurements (r = .10). A repeated measures multivariate analysis of variance demonstrated that visual and auditory biofeedback of EMG during pelvic floor contractions increases intravaginal pressure when compared with trials without biofeedback. Potential benefits of fabric electrodes include reduced invasiveness and risk and the ease with which patients can utilize this technology for home practice.

Variation in intravaginal pressure measurements

The wide variation in intravaginal pressure measurements of the circumvaginal muscles (CVM) was studied in five subjects under well-controlled conditions. Previous research and clinical observations have indicated that fluctuations in the measurement of intravaginal pressure may be associated with time of day, day of testing, and existing stress factors. Subjects were assessed four times per day, on four consecutive days, for a total of 16 assessments. At each of the 16 conditions for a given subject, 10 CVM contractions lasting 12 seconds each were recorded and the variables, maximum pressure (MP10), peak maximum pressure (PMP), and abdominal pressure were analyzed. The within-subject variance was 15.5 (SD = 3.9); the between-subject variance was 132.4 (SD = 11.5). The effects of day, time, and stressor were analyzed by ANOVA specifically designed for variance estimates; no significant differences were found. The clinical observations that led to the study were not supported when systematically investigated. However, consistent data collection procedures appeared to reduce within-subject variance.

Dynamic characteristics of the circumvaginal muscles during pregnancy and the postpartum

Weakened circumvaginal muscles (CVM) may occur after childbirth and may be associated with obstetric factors such as perineal outcome, episiotomy, length of second stage labor, baby weight, and pushing technique. Pressures developed by the CVM during pregnancy and postpartum were obtained to test the hypothesis that significantly lower pressures would be developed by the CVM in the early postpartum than during pregnancy. The sample consisted of 29 pregnant women who planned to deliver at a birth center. A follow-up study was performed approximately one year after delivery to determine if improvement of the CVM occurred over time. The results supported the hypothesis and indicated that restitution of the CVM occurred after the early postpartum period.

Stress urinary incontinence: effect of pelvic muscle exercise

Twenty women with stress urinary incontinence diagnosed by urodynamic testing participated in a 6-week pelvic muscle exercise program. The aim of the study was to evaluate the effectiveness of the exercise program, with or without an intravaginal balloon, on urinary leakage as determined by a 30-minute and a 24-hour pad test. Relative strength of the pelvic muscles was evaluated using an intravaginal device that measures the pressure generated during a muscle contraction. After completion of the exercise program, 18 of the 20 subjects had an increase in strength of the pelvic floor muscles, as demonstrated by increased intravaginal pressure or a decrease in urinary loss on the 24-hour pad test. The use of an intravaginal balloon did not improve performance of the pelvic muscles or decrease urinary loss as compared with the subjects who exercised without an intravaginal balloon. Twelve months after the completion of the exercise program, 19 of the participants responded to a questionnaire about their urinary loss and performance of pelvic muscle exercises. None of the subjects stated that her urinary loss was worse, three had undergone surgical intervention, and ten had not continued to exercise. Seven subjects still exercised, with subjective improvement of urinary loss. It appears that pelvic muscle exercises may be successful in improving the condition of stress urinary incontinence; however, half of the subjects did not continue to exercise independently.

The effect of exercise on the circumvaginal muscles in postpartum women

The effect of exercise on pressure developed by the circumvaginal muscles (CVM) in postpartum women was studied. The CVM assessment system described earlier by Dougherty, Abrams, and McKey used an intravaginal balloon device (IVBD) developed from an impression and model of the vagina. The system (IVBD, pressure transducer and strip chart recorder) provided permanent CVM pressure tracings with high test-re-test reliability (n = 16; r = .85) for maximum pressure (MP). The hypothesis in the research reported here was that exercise with and without an IVBD, when compared to no exercise, would result in significantly higher MP and pressure over time (POT). Forty-five healthy PP volunteers were randomly assigned to a 10-minute per day home training program, for six weeks. The baseline and six-week assessments consisted of CVM pressure tracings during contraction. Dependent variables were MP (highest pressure attained) and POT (area under the pressure curve). Although no significant differences were found between the home training groups, greater improvement was found in the exercise groups. Variability within subjects partly accounts for the results. Pressure changes before and after pregnancy and before and after CVM exercise are demonstrated in a case study. The findings support the use of CVM exercise in the postpartum.

The dynamic characteristics of the circumvaginal muscles

Circumvaginal muscle (CVM) maximum pressure was studied as related to the postpartal period, parity, type of birth, episiotomy, age, breastfeeding, physical activity, body mass, stress urinary incontinence, and orgasm in a sample of 98 healthy postpartal and nonpostpartal women. Circumvaginal muscle pressure tracings were obtained from these women using a pressure-sensitive, intravaginal balloon device. Correlations between circumvaginal muscle maximum pressures and episiotomy, age, breastfeeding, physical activity, body mass, stress urinary incontinence, and orgasm were either not significant or only weakly significant. However, Duncan's multiple range test showed differences in the maximum pressures between groups (nulliparous, parity greater than 0, cesarean delivery, and vaginal delivery) and indicated that vaginal birth has a marked weakening effect on the circumvaginal muscles.

The circumvaginal musculature: correlation between pressure and physical assessment

This study assessed two recently developed techniques to assess the circumvaginal musculature (CVM), the CVM Rating Scale and the pressure sensitive intravaginal balloon device (IVBD), and correlated results of the two methods. Thirty women volunteers, aged 20 to 42, were studied. CVM Rating Scale total scores and IVBD maximal contraction variables were measured for resting pressure, rate of rise, maximal pressure, rate of return, and time that a submaximal contraction could be sustained (endurance contraction). Age, parity, self-reported orgasm, self-reported Kegel exercises, and self-reported physical exercise were separately correlated with CVM Rating Scale total scores and IVBD maximal pressure results. A positive significant correlation was found between the CVM Rating Scale total scores and the IVBD maximal contraction results for the variables rate of rise, r = .50, p less than .01, maximum pressure, r = .82, p less than .01, and rate of return, r = .44, p less than .01. Self-reported orgasm had a positive significant correlation to the CVM Rating Scale total scores, rho = .34, p less than .05, and to the IVBD maximal pressure results, r = .52, p less than .01. A positive correlation was found between self-reported physical exercise and the CVM Rating Scale total scores, rho = .31, p less than .05. IBVD maximal pressure results were negatively correlated with age, r = -.34, p less than .05, and parity, r = -.34, p less than .05.

An instrument to assess the dynamic characteristics of the circumvaginal musculature

This report describes an intravaginal balloon device (IVBD) and an improved method for measuring the dynamic characteristics of circumvaginal muscle (CVM) contractions. The IVBD measurement system may be used in research on women's health problems related to the pelvic floor musculature. The system is independent of examiner judgment and variability, and measurement conditions are carefully controlled. In an initial trial using the device with 20 volunteers, aged 22 to 58 years, the maximal pressure developed during strong CVM contractions was measured with the subjects supine. Subjects were asked to repeat the contraction while they contracted abdominal muscles. The length of time a submaximal contraction could be held was also measured. Test-retest reliability, determined by repeating each experiment, revealed significant correlations in maximal pressure attained, r = .85, p less than .03. A t test demonstrated no significant difference between the variables with and without the use of abdominal muscles, indicating the contraction of abdominal muscles did not affect intravaginal pressure when assessed with the IVBD. A weak correlation between length of time a submaximal contraction could be held and age of subject was found, r = -.44, p less than .06, but no pressure variable was correlated with age or parity, a possible effect of the small sample in this study.

Development and testing of the circumvaginal muscles rating scale

The purpose of this research was to develop an instrument for clinical assessment of the circumvaginal muscles (CVM), to test the reliability of the instrument, and to correlate sample characteristics with this instrument. The 9-point CVM Rating Scale is based on four components: pressure, duration, muscle ribbing, and position of the examiner's finger during examination. Reliability of the CVM Rating Scale was ascertained by use of interrater and test-retest reliability. Interrater reliability was tested on two separate occasions, N = 10, rho = 0.6, p less than .04; N = 10, rho = 0.7, p less than .05. A test-retest sequence was conducted 10 days apart, N = 10, rho = 0.9, p less than .003. Results from these tests indicated that the CVM Rating Scale is a reliable instrument for assessing CVM. A convenience sample of 30 women, aged 18-37, in good general health was tested, using the CVM Rating Scale. Women with a history of pelvic floor reconstructive surgery were excluded. A significant positive correlation between self-reported orgasm and the CVM Rating Scale total scores was found, chi 2 = 7.5, p less than .02. No significant correlations were found between age, race, parity, episiotomy, or self-reported Kegel exercises and the CVM Rating Scale total scores. The scale is a cost-effective, time-efficient, systematic assessment, accessible in clinical settings.

Custom-made vaginal balloons for strengthening circumvaginal musculature

A technique for making individualized silicone rubber intravaginal balloons is described. The method entails investing alginate vaginal impressions in silicone rubber and casting a resin model which is then dipped repeatedly in a Silastic Dispersion (Dow Corning, Q7-2213). The range of forces developed by circumvaginal muscles during maximum contractions was determined to be 0.5-4 lbs. Pressure-volume relationships of the balloons showed that the pressure of filling fluid was an accurate replica of the mean pressure in the vagina.

Lipids and lipoproteins in women after oophorectomy and the response to oestrogen therapy

The short-term effects of different types and doses of oestrogen on serum lipids and lipoproteins were studied in 35 oophorectomized women. After 3 months treatment, serum cholesterol levels were unaffected by 1 and 2 mg of micronized 17 beta-oestradiol or 0.625 and 1.25 mg of conjugated equine oestrogens. Triglyceride levels were significantly elevated after treatment with 1.25 mg of conjugated oestrogens. A trend towards a higher relative proportion of high-density lipoproteins and a lower relative proportion of low-density lipoproteins was observed for all four oestrogen regimens, however, statistical significance was not achieved. The proportion of very-low-density lipoprotein was unaffected by oestrogen treatment. The age of the oophorectomized women was found to have no effect on either the direction or magnitude of the lipid or lipoprotein responses to oestrogen. Using FSH depression as an index, 1.25 mg of conjugated oestrogens was found to be the most potent of the four oestrogen regimens tested. Therefore, with respect to lipid balance, little additional clinical benefit is achieved by using a more potent regimen and the risk of adverse side effects may be increased.

Oestrogen--progestin therapy and the lipid balance of post-menopausal women

The lipid and lipoprotein profiles of 20 post-menopausal women treated with cyclic conjugated oestrogens (0.625 or 1.25 mg) and medroxyprogesterone acetate (10 mg for 7 days) were compared to those of 18 untreated women of similar age and menopausal status. No statistically significant between-group differences were observed during the 18-mth period for cholesterol, triglycerides or lipoprotein distribution. After 12 mth, a significant shift in lipoprotein distribution manifested in the treated and untreated groups. The proportion of high-density lipoproteins significantly increased and that of the low-density lipoproteins significantly decreased. Although the shift was more pronounced in the treated group, there was no significant difference between the treated and untreated groups. These results indicated that such relatively nonandrogenic progestins as medroxyprogesterone acetate, have no adverse effects on the lipid milieu of post-menopausal women when used with long-term oestrogen therapy.