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1.
AIMS: To investigate the muscle activation patterns of the abdomino-pelvic region used by incontinent women during a pelvic floor muscle (PFM) contraction and a Valsalva manouevre compared to healthy, asymptomatic subjects. METHODS: Thirteen incontinent (symptomatic) women, identified using ultrasound to be consistently depressing the bladder base during PFM contraction, and thirteen continent women (asymptomatic) able to perform an elevating PFM contraction were assessed using surface electromyography (EMG) of the PFM, abdominal and chest wall muscles and vaginal and intra-abdominal pressure (IAP) measurements during PFM contraction and Valsalva under ultrasound surveillance. RESULTS: There were no differences between groups in age, parity or BMI. There was a difference in muscle activation patterns between groups (P = 0.001). During PFM contraction the PFM were less active and the abdominal and chest wall muscles were more active in the symptomatic group. During Valsalva, the PFM and EO were more active in the symptomatic group but there was no difference in the activation of the other muscles between groups. There was a significant interaction (group x pressure) for change in IAP (P = 0.047) but no significant interaction for change in vaginal pressure (VP) (P = 0.324). CONCLUSIONS: The symptomatic women displayed altered muscle activation patterns when compared to the asymptomatic group. The symptomatic women were unable to perform a voluntary PFM contraction using a localized muscle strategy, instead activating all the muscles of the abdomino-pelvic cavity. The potential for muscle substitution strategies reinforces the need for close attention to specificity when prescribing PFM exercise programs. 相似文献
2.
The present investigation comprises three methodological studies concerning vaginal pressure measurements of pelvic floor muscle (PFM) strength. Vaginal pressure was measured by a balloon (6.7 ± 1.7 cm) connected by a catheter to a pressure transducer. The balloon was placed with the middle of the balloon 3.5 cm inside the introitus vagina. In fourty-seven women, mean age 44.9 years (24–64), observation of movement of the vaginal catheter during PFM contraction verified 7 inconclusive results from perineovaginal palpation and was the most valid way to distinguish between correct and incorrect PFM contraction. Vaginal pressure rise was obtained regardless of correct or incorrect PFM contraction, showing that vaginal pressure is not specific for PFM contraction. However, as the action of the PFM is elevation, a simultaneous inward movement of the vaginal catheter is present only during correct PFM contraction. Degree of influence of various muscle groups on vaginal pressure was investigated in 14 women using two different balloons, one having a silicone reinforcement of the tip. It was found that the median contraction value of muscles other than the PFM did not exceed contraction of PFM alone. No significant difference was observed using the two types of balloons. In three physical therapists EMG activity of the lower m. rectus abdominis was recorded during maximal PFM contractions. A rise in EMG activity always occurred during maximal contractions even if the women actively tried to relax the abdominal muscles. It is concluded that vaginal pressure measurement of PFM strength is valid with simultaneous observation of inward movement of the balloon catheter. Vaginal pressure rise due to simultaneous contraction of other muscles is probably not larger than pressure rise due to intended PFM contraction. Reinforced balloon tip will not change pressure recording, and rise in EMG activity of lower abdominal muscles seems unavoidable during maximal PFM contraction. 相似文献
3.
Judith A. Thompson Peter B. O’Sullivan N. Kathryn Briffa Patricia Neumann 《International urogynecology journal》2007,18(7):779-786
Transperineal (TP) and transabdominal (TA) ultrasounds were used to assess bladder neck (TP) and bladder base (TA) movement
during voluntary pelvic floor muscle (PFM) contraction and functional tasks. A sonographer assessed 60 asymptomatic (30 nulliparous,
30 parous) and 60 incontinent (30 stress, 30 urge) women with a mean age of 43 (SD = 7) years, BMI of 24 (SD = 4) kg m2 and a median parity of 2 (range, 0–5), using both ultrasound methods. The mean of three measurements for bladder neck and
bladder base (sagittal view) movement for each task was assessed for differences between the groups. There were no differences
in bladder neck (p = 0.096) or bladder base (p = 0.112) movement between the four groups during voluntary PFM contraction but significant differences in bladder neck (p < 0.004) and a trend towards differences in bladder base (p = 0.068) movement during Valsalva and abdominal curl manoeuvre. During PFM contraction, there was a strong trend for the
continent women to have greater bladder neck elevation (p = 0.051), but no difference in bladder base movement (p = 0.300), when compared to the incontinent women. The incontinent women demonstrated increased bladder neck descent during
Valsalva and abdominal curl (p < 0.001) and bladder base descent during Valsalva (p = 0.021). The differences between the groups were more marked during functional activities, suggesting that comprehensive
assessment of the PFM should include functional activities as well as voluntary PFM contractions. TP ultrasound was more reliable
and takes measures from a bony landmark when compared to TA ultrasound, which lacks a reference point for measurements. TA
ultrasound is less suitable for PFM measures during functional manoeuvres and comparisons between subjects. Few subjects were
overweight so the results may not be valid in an obese population. 相似文献
4.
Judith A. Thompson Peter B. O’Sullivan N. Kathryn Briffa Patricia Neumann 《International urogynecology journal》2006,17(6):624-630
The aims of the study were: (1) to assess women performing voluntary pelvic floor muscle (PFM) contractions, on initial instruction without biofeedback teaching, using transperineal ultrasound, manual muscle testing, and perineometry and (2) to assess for associations between the different measurements of PFM function. Sixty continent (30 nulliparous and 30 parous) and 60 incontinent (30 stress urinary incontinence (SUI) and 30 urge urinary incontinence (UUI)) women were assessed. Bladder neck depression during attempts to perform an elevating pelvic floor muscle (PFM) contraction occurred in 17% of continent and 30% of incontinent women. The UUI group had the highest proportion of women who depressed the bladder neck (40%), although this was not statistically significant (p=0.060). The continent women were stronger on manual muscle testing (p=0.001) and perineometry (p=0.019) and had greater PFM endurance (p<0.001) than the incontinent women. There was a strong tendency for the continent women to have a greater degree of bladder neck elevation than the incontinent women (p=0.051). There was a moderate correlation between bladder neck movement during PFM contraction measured by ultrasound and PFM strength assessed by manual muscle testing (r=0.58, p=0.01) and perineometry (r=0.43, p=0.01). The observation that many women were performing PFM exercises incorrectly reinforces the need for individual PFM assessment with a skilled practitioner. The significant correlation between the measurements of bladder neck elevation during PFM contraction and PFM strength measured using MMT and perineometry supports the use of ultrasound in the assessment of PFM function; however, the correlation was only moderate and, therefore, indicates that the different measurement tools assess different aspects of PFM function. It is recommended that physiotherapists use a combination of assessment tools to evaluate the different aspects of PFM function that are important for continence. Ultrasound is useful to determine the direction of pelvic floor movement in the clinical assessment of pelvic floor muscle function in a mixed subject population. 相似文献
5.
AIM: Activation of the abdominal muscles might contribute to the generation of a strong pelvic floor muscle contraction, and consequently may contribute to the continence mechanism in women. The purpose of this study was to determine the abdominal muscle activation levels and the patterns of muscle activity associated with voluntary pelvic floor muscle (PFM) contractions in urinary continent women. METHODS: Fifteen healthy continent women participated. They performed three maximal contractions of each of the four abdominal muscles and of their PFMs while in supine. Abdominal and PFM activity was recorded using electromyography (EMG), and intravaginal pressure was recorded using a custom modified Femiscan probe. RESULTS: During voluntary maximal PFM contractions, rectus abdominus was activated to 9.61 (+/-7.42)% maximal voluntary electrical activity (MVE), transversus abdominus was activated to 224.30(+/-47.4)% MVE, the external obliques were activated to 18.72(+/-13.33)% MVE, and the internal obliques were activated to 81.47(+/-63.57)% MVE. A clear pattern of activation emerged, whereby the transversus abdominus, internal oblique, and rectus abdominus muscles worked with the PFM in the initial generation of maximal intravaginal pressure. PFM activity predominated in the initial rise in lower vaginal pressure, with later increases in pressure (up to 70% maximum pressure) being associated with the combined activation of the PFM, rectus abdominus, internal obliques, and transverses abdominus. These abdominal muscles were the primary source of intravaginal pressure increases in the latter 30% of the task, whereas there was little increase in PFM activation from this point on. The external oblique muscles showed no clear pattern of activity, but worked at approximately 20% MVE throughout the PFM contractions, suggesting that their role may be predominantly in postural setting prior to the initiation of intravaginal pressure increases. CONCLUSIONS: Defined patterns of abdominal muscle activity were found in response to voluntary PFM contractions in healthy continent women. 相似文献
6.
U. M. Peschers A. Gingelmaier K. Jundt B. Leib T. Dimpfl 《International urogynecology journal》2001,12(1):27-30
The aim of the study was to evaluate whether four different techniques were able to correctly measure pelvic floor muscle
strength only. Sixteen volunteers performed a set of muscle contractions using the pelvic floor muscles (PFM) only, the abdominal
muscles with and without PFM, gluteal muscles with and without PFM, adductor muscles with and without PFM and Valsalva maneuver
with and without PFM. Pelvic floor muscle strength was evaluated by digital palpation, intravaginal EMG, pressure perineometry
and perineal ultrasound. A “non-pelvic muscle induced” reading was defined as a significant increase even though the pelvic
floor muscles were not contracted. Results were as follows: isolated abdominal muscle contraction: non-pelvic muscle induced
readings in 3/8 women with EMG and in 3/8 with pressure perineometry; isolated gluteal muscle contraction: non-pelvic muscle
induced readings in 1/2 women with EMG perineometry; isolated adductor muscle contraction: non-pelvic muscle induced readings
in 6/11 women with EMG perineometry and in 2/11 women with pressure perineometry; Valsalva maneuver: non-pelvic muscle induced
readings in 4/9 women with EMG perineometry and 9/9 women with pressure perineometry. It was concluded that EMG and pressure
perineometry do not selectively depict pelvic floor muscle activity. 相似文献
7.
Stéphanie J. Madill Marie-Andrée Harvey Linda McLean 《International urogynecology journal》2009,20(4):447-459
Introduction and hypothesis To compare maximum abdominal and pelvic floor muscle (PFM) electromyographic (EMG) and intravaginal pressure (IVP) amplitudes
and muscle activation patterns during voluntary PFM contractions between women with and without stress urinary incontinence
(SUI).
Methods Twenty-eight continent women and 44 women with SUI performed single and repeated PFM contractions in supine. Surface EMG data
were recorded simultaneously with IVP. Maximum EMG and IVP amplitudes and ensemble average IVP versus EMG curves were determined
from the single contractions. Muscle activation timing was determined with cross-correlation functions from the repeated contractions.
Results The continent group produced higher PFM EMG amplitudes than the SUI group; there were no between group differences in IVP.
The women with SUI delayed activating rectus abdominus. The IVP versus EMG curves’ shapes were similar between the groups,
however the SUI group had higher abdominal muscle y-intercepts than the continent women.
Conclusions These findings suggest that women with SUI demonstrate altered motor control strategies during voluntary PFM contractions. 相似文献
8.
Assessment of pelvic floor movement using transabdominal and transperineal ultrasound 总被引:3,自引:3,他引:0
Judith A Thompson Peter B O’Sullivan Kathy Briffa Patricia Neumann Sarah Court 《International urogynecology journal》2005,16(4):285-292
The aims of the study were (1) to assess the reliability of transabdominal (TA) and transperineal (TP) ultrasound during a pelvic floor muscle (PFM) contraction and Valsalva manoeuvre and (2) to compare TA ultrasound with TP ultrasound for predicting the direction and magnitude of bladder neck movement in a mixed subject population. A qualified sonographer assessed 120 women using both TA and TP ultrasound. Ten women were tested on two occasions for reliability. The reliability during PFM was excellent for both methods. TP ultrasound was more reliable than TA ultrasound during Valsalva. The percentage agreement between TA and TP ultrasound for assessing the direction of movement was 85% during PFM contraction, 100% during Valsalva. There were significant correlations between the magnitude of the measurements taken using TA and TP ultrasound and significant correlations with PFM strength assessed by digital palpation. 相似文献
9.
The aim of the present study was to describe co-activity patterns of the striated urethral wall muscle and the pelvic floor muscles (PFM) during contraction of outer pelvic muscles. Six healthy nulliparous physical education students, mean age 19.5 years (19–21) participated in the study. Concentric needle EMG and a Dantec amplifier were used for registrations. EMG activity was continuously recorded with the participants lying in a supine position. EMG was recorded during relaxation, contraction of the PFM. valsalva maneuver, coughing, hip adductor contraction, gluteal muscle contraction, backward tilting of the pelvis, and sit-ups. The procedure was performed with the needle in the striated muscle of the anterior wall of the urethra and then repeated with the needle set lateral to the urethra in the PFM. The results showed that the striated urethral wall muscle was contracted synergistically during PFM, hip adductor, and gluteal muscle contraction, but not during abdominal contraction. Both hip adduction, gluteal muscle, and abdominal muscle contraction gave synergistic contraction of the PFM. Thus the urethral wall striated muscle and the PFM react differently during abdominal contraction. © 1994 Wiley-Liss, Inc. 相似文献
10.
Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements 总被引:4,自引:0,他引:4
Morin M Bourbonnais D Gravel D Dumoulin C Lemieux MC 《Neurourology and urodynamics》2004,23(7):668-674
AIMS: To compare the pelvic floor muscle (PFM) function in continent and stress urinary incontinent women using dynamometric measurements. METHODS: Thirty continent women and 59 women suffering from stress urinary incontinence (SUI), aged between 21 and 44 and parous, participated in the study. An instrumented speculum was used to assess the static parameters of the PFM: (1) passive force at 19 and 24 mm of vaginal aperture (antero-posterior diameter), (2) maximal strength in a self-paced effort at both apertures, (3) rate of force development and number of contractions during a protocol of rapidly repeated 15-sec contractions, and lastly (4) absolute endurance recorded over a 90-sec period during a sustained maximal contraction. The parameters described in the two latter conditions were assessed at the aperture of 19 mm. Analyses of covariance were used to control the confounding variables of age and parity when comparing the PFM function in the continent and incontinent women. RESULTS: The continent women demonstrated higher passive force at both openings and a higher absolute endurance as compared to the incontinent women (P < or = 0.01). In the protocol of rapidly repeated contractions, the rate of force development and number of contractions were both lower in the incontinent subjects (P < or = 0.01). The differences between the two groups for maximal strength at the 19- and 24-mm apertures did not reach the statistically significant level. CONCLUSIONS: The PFM function is impaired in incontinent women. The assessment of PFM should not be restricted to maximal strength. Other parameters that discriminate between continent and incontinent women need to be added to the PFM assessment in both clinical and research settings. 相似文献
11.
The purpose of the study was to compare the effect of voluntary pelvic floor muscle (PFM) contraction and vaginal electrical stimulation on urethral pressure. Twelve women with genuine stress incontinence, mean age 49.4 years (range 33–66) participated in the study. The urethral and bladder pressures were recorded simultaneously through a double-lumen 8 Ch catheter. The patients first performed three voluntary PFM contractions. Then two electrical stimulators, Conmax and Medicon MS 105, 50 Hz, were used in random order. A visual analog scale was used to measure pain and discomfort. Pain was reported to mean 6.8, SEM 0.64 (range 0.7–9.9) and mean 6.1, SEM 0.81 (range 0–9.1) with Conmax and Medicon MS 105, respectively. The mean paired difference in favor of voluntary contraction with Conmax was ?8.0, SD 6.7,P=0.0067, and with Medicon MS 105 it was ?12.2, SD 5.9,P=0.0022. The results demonstrated that voluntary PFM contraction increased urethral pressure significantly more than did vaginal electrical stimulation. 相似文献
12.
Deffieux X Hubeaux K Porcher R Ismael SS Raibaut P Amarenco G 《Neurourology and urodynamics》2008,27(4):291-296
AIMS: To assess how muscular fatigue deteriorates the modulation of pelvic contraction during increasing cough efforts. Furthermore, we investigated the correlation between the temporal course of pelvic floor activation during cough. METHODS: Informed consent was obtained from 20 women presenting with SUI and 6 continent women (overactive bladder syndrome [OAB]). Bladder pressure (BP) and external anal sphincter electromyographic activity (EAS EMGi) were recorded concomitantly during increasing cough efforts. Modulation of pelvic contraction was assessed before and after two types of intense pelvic exercise (Exercise #1: 10 successive strong cough efforts; Exercise #2: 10 pelvic contractions followed by a maximal pelvic contraction) at 0, 200, and 400 ml of bladder filling. We have also recorded electromyographic activity of external intercostal (EIC) muscles. RESULTS: Whereas the Exercise 1 had no effect on modulation, the Exercise 2 altered significantly the modulation of pelvic contraction during increasing cough efforts (P = 0.043) only in women presenting with SUI. The bladder filling volume seems to not significantly modify this modulation (P = 0.12). Median latency between the onset of the EAS EMGi and the onset of the EIC EMGi was -470 and -60 msec in OAB group and in SUI group, respectively (P = 0.012). There was a good correlation between mean latency (default of EAS EMGi pre-activation) and an altered modulation of pelvic contraction during increasing cough efforts (P = 0.040). CONCLUSIONS: Some women with SUI exhibit an altered pattern of the PFM response during increasing coughing efforts. The lack of this modulation of PFM response to stress may be one of the pathophysiologic factors of SUI. 相似文献
13.
Baerbel Junginger Kaven Baessler Ruth Sapsford Paul W. Hodges 《International urogynecology journal》2010,21(1):69-77
Introduction and hypothesis
Although the bladder neck is elevated during a pelvic floor muscle (PFM) contraction, it descends during straining. This study aimed to investigate the relationship between bladder neck displacement, electromyography (EMG) activity of the pelvic floor and abdominal muscles and intra-abdominal pressure (IAP) during different pelvic floor and abdominal contractions. 相似文献14.
Clinical evaluation of pelvic floor muscle function in continent and incontinent women 总被引:3,自引:0,他引:3
Devreese A Staes F De Weerdt W Feys H Van Assche A Penninckx F Vereecken R 《Neurourology and urodynamics》2004,23(3):190-197
AIMS: The aim of the study was to investigate the reliability of a scoring system for the investigation of voluntary and reflex co-contractions of abdominal and pelvic floor muscles in lying, sitting, and standing positions in continent and incontinent women. METHODS: A visual inspection and digital (strength, tone, speed, and endurance) palpation scale was developed to measure the coordination of the lower abdominal and pelvic floor muscles. Inter-observer reliability of the scales was investigated in 40 continent and 40 incontinent women. Differences between the continent and incontinent group were analysed. RESULTS: Inter-observer reliability for the visual inspection scale showed kappa values between 0.91 and 1.00, for tone percentage of agreement ranged from 95 to 100% (superficial) and 95 to 98% (deep muscle). Weighted Kappa (K(w)) varied from 0.77 to 0.95 for strength and 0.75 to 0.98 for the inward movement of superficial and deep pelvic floor muscles. K(w) for coordination between the superficial and deep part of the pelvic floor muscles groups was from 0.87 to 0.88 and 0.97 to 1.00 for endurance and global speed of the pelvic floor contraction. The continent women exhibited significantly better coordination between the pelvic floor and lower abdominal muscles during coughing in all three positions. Also the superficial part of the inward movement, the feeling and the coordination of the pelvic floor muscles were significantly better in the continent group. CONCLUSIONS: Visual inspection and digital tests are easy and reliable methods by which insight can be gained into the multi-muscular activity and coordination of the pelvic floor and lower abdominal muscles in continent and incontinent women. 相似文献
15.
Kari B 《Neurourology and urodynamics》1992,11(2):107-113
The purpose of the present investigation was to assess whether different positions of the vaginal measuring device affect the pressure readings during pelvic floor muscle (PFM) contraction. Twelve women with stress urinary incontinence (SUI) participating in a PFM exercise program, volunteered for the study. The diagnosis of SUI was based on urodynamic investigation and pad test. The mean age of the women was 40.9 years (24–50). The women performed three PFM contractions with a vaginal balloon placed in four different positions: 1) against the vaginal vault and in the posterior fornix, 2) in the proximal upper third of the vagina, 3) with the middle of the balloon 3.5 cm from the introitus vagina and 4) with half of the balloon outside the introitus vagina. The results demonstrated significant differences between recordings from the four vaginal positions: position 1, median pressure 5 cm H2O; position 2, 9 cm H2O; position 3, 15 cm H2O; and position 4, 8 cm H2O. It is concluded that the position of the vaginal device affects the results. This may be one important factor which could explain the variability of vaginal pressure recordings during PFM contractions. For most women the highest pressure was recorded in position 3. © 1992 Wiley-Liss, Inc. 相似文献
16.
AIMS: Firm bladder neck support during cough, suggested to be needed for effective abdominal pressure transmission to the urethra, might depend on activity of the levator ani muscle and elasticity of endopelvic fascia. METHODS: The study group of 32 patients with stress urinary incontinence and hypermobile bladder neck, but without genitourinary prolapse, were compared with the control group of 28 continent women with stable bladder neck. The height of the bladder neck (HBN) and compliance of the bladder neck support (C) were assessed, the latter by the quotient of the bladder neck mobility during cough and the change in abdominal pressure. By using wire electrodes, the integrated full-wave rectified electromyographic (EMGave) signal of the levator ani muscle was recorded simultaneously with urethral and bladder pressures. The pressure transmission ratio (PTR), time interval between the onset of muscle activation and bladder pressure increment (DeltaT), and area under the EMGave curve during cough (EMGcough) were calculated. From bioptic samples of endopelvic fascia connecting the vaginal wall and levator ani muscle, elastic fiber content was assessed by point counting method. Mann-Whitney test was used to compare all the variables. Correlations between the parameters were evaluated by using the Spearman correlation coefficient. RESULTS: In the study group, HBN was significantly lower (P < 0.001), C was significantly greater (P < 0.001), and PTR was significantly lower (P < 0.001). In the study group, the muscular activation started later (median, DeltaT(l), -0.147 second; DeltaT(r), -0.150 second), and in the control group, it preceded (DeltaT(l), 0.025 second; P < 0.001; DeltaT(r), 0.050 second; P < 0.001) the bladder pressure increment. EMGcough on the left side was significantly greater in the study group (P < 0.046). Elastic fiber content showed no difference between the groups. The analysis of all patients revealed negative correlations between C and PTR (r = -0.546; P < 0.001) and between C and DeltaT(l) (r = -0.316; P < 0.018). CONCLUSIONS: Firm bladder neck support enables effective pressure transmission. Timely activation of the levator ani seems to be an important feature. 相似文献
17.
Bø K 《Neurourology and urodynamics》2003,22(7):654-658
AIMS: Several randomized controlled trials have demonstrated that pelvic floor muscle training is effective to treat stress urinary incontinence. The aim of the present study was to compare muscle strength increase and maximal strength in responders and non-responders to pelvic floor muscle training. MATERIALS AND METHODS: Fifty-two women with urodynamically proven stress incontinence who had participated in a six months randomized controlled trial on pelvic floor muscle training, mean age 45.4 years (range 24-64), participated in the study. The women were classified as responders and non-responders based on a combination of five effect variables covering urodynamic measurement, pad test with standardized bladder volume, and self-reports. Pelvic floor muscle strength was measured with a vaginal balloon connected to a fiber optic micro tip transducer (Camtech AS, Sandvika, Norway). RESULTS: There was a positive correlation between improvement in PFM maximal strength and improvement measured by leakage index (r = 0.34, P < 0.01), and reduction in urinary leakage measured by the pad test (r = 0.23, P = 0.05). The total sample of 52 women comprised 21 responders, 18 unclassifiable, and 13 non-responders. There was a statistically significant difference in maximal strength after the training period between responders and non-responders; 24.0 cm H2O (95% CI:18.1-29.9) versus 12.7 cm H2O (95% CI: 6.8-18.6) P < 0.001), and strength increase; 14.8 cm H2O (95% CI: 8.9-20.7) versus 5.0 cm H2O (95% CI: 2.6-12.6), respectively (P = 0.03). CONCLUSIONS: There was a positive relation between both pelvic floor muscle strength increase and maximal strength, and improvement of stress urinary incontinence. 相似文献
18.
BACKGROUND: Intra-abdominal pressure (IAP) measurements can be used for the early detection and management of the abdominal compartment syndrome. IAP values are widely thought to be atmospheric or subatmospheric. However, there are no reports that describe normal IAP values using urinary bladder pressure measurements in patients not suspected of having a raised IAP level. This study sought to determine these normal values to aid our interpretation of IAP measurements in post-surgical patients or patients with suspected increased IAP. METHODS: Urinary bladder pressure measurements were carried out in 40 men and 18 women awake medical or non-abdominal surgery inpatients with existing indwelling catheters. Measurements were made in the supine, 30 degrees and 45 degrees sitting positions. Comparisons were carried out to determine the effects on urinary bladder pressure of body position, sex and a suspected diagnosis of benign prostatic hypertrophy. RESULTS: Median values for IAP were higher if measured in a more upright position (P < 0.0001). Median values were supine, 9.5 cmH2O (range, 1-18 cmH2O); 30 degrees upright, 11.5 cmH2O (range, 3-19 cmH2O); and at 45 degrees upright, 14.0 cmH2O (range, 4-22 cmH2O). Measurements recorded were neither atmospheric nor subatmospheric. IAP was higher in men compared with women in the supine and 30 degrees positions (P < 0.05) but not in the 45 degrees position (P = 0.083). There was no significant difference between patients with and without suspected benign prostatic hypertrophy. CONCLUSIONS: Normal IAP using urinary bladder pressure in awake patients are above atmospheric pressure. As a patient is moved from the supine into the upright position, IAP measurements increase. 相似文献
19.
Kari B Rolf H. Hagen Bernt Kvarstein Jan Jrgensen Stig Larsen Kathryn L. Burgio 《Neurourology and urodynamics》1990,9(5):489-502
Fifty-two women, mean age 45.9 years (24–64) with clinically and urodynamically proven stress urinary incontinence (SUI) were randomly assigned to one of two different pelvic floor muscle (PFM) exercise groups. Both groups performed 8–12 maximal PFM contractions 3 times a day for 6 months. In addition one group exercised with an instructor intensively 45 min once a week performing long-lasting contractions with the supplement of 3–4 fast contractions at the end of each long-lasting contraction. Initially and after 6 months an examination was performed comprising history, urinary leakage index, pad test, maximum urethral closure pressure, functional urethral profile length, and recording of vaginal pressure during PFM contractions. The latter was performed monthly. After the treatment 60% of the intensive exercise (IE) group and 17.3% of the home exercise (HE) group reported to be continent or almost continent (P < .01). Only the IE group demonstrated significant reduction in urine loss; from mean 27 g to 7.1 g (P < .01) and improvement in maximum resting urethral closure pressure (mean improvement 4.6 cm H2O. P = .02). PFM strength improved with mean 15.5 cm H2O (P < .01) in the IE group while the HE group improved with 7.4 cm H2O (P < .01). It is concluded that the results of PFM exercise for female SUI is highly dependent upon the degree and duration of treatment and frequent supervision by the therapist. 相似文献
20.
The aim of the study was to measure pelvic floor muscle function in continent and incontinent nulliparous pregnant women. The study group consisted of 103 nulliparous pregnant women at 20 weeks of pregnancy. Women reporting urinary incontinence once per week or more during the previous month were classified as incontinent. Function was measured by vaginal squeeze pressure (muscle strength) and increment in thickness of the superficial pelvic floor muscles (urogenital diaphragm) assessed by perineal ultrasound. Seventy-one women were classified as continent and 32 women as incontinent. Continent women had statistically significantly higher maximal vaginal squeeze pressure and increment in muscle thickness when compared with incontinent women. There was a strong correlation between measurements of vaginal squeeze pressure and perineal ultrasound measurements of increment in muscle thickness. This study demonstrates statistically significant differences in pelvic floor muscle function measured by strength and thickness in continent compared with incontinent nulliparous pregnant women. Editorial Comment: This study evaluated pelvic floor muscle function in 103 nulliparous continent and incontinent women at 18–20 weeks gestation. Pelvic floor muscle strength was assessed by measuring vaginal squeeze pressure, and thickness of the urogenital diaphragm during both relaxation and contraction was measured using perineal ultrasound. The authors found a statistically significant higher vaginal squeeze pressure and higher mean increment in muscle thickness in the continent compared with incontinent group as well as a strong correlation between pelvic floor muscle strength and increment in thickness. Although describing several benefits of ultrasonography in assessing pelvic floor muscles, the authors did acknowledge the difficulty in identifying and measuring these muscles, and the learning curve involved with perineal ultrasound. Another limitation was the subjective classification of continence status based on self-reported symptoms. The implication of low pelvic floor muscle strength and thickness as risk factors for the development of urinary incontinence is beyond the scope of this study. 相似文献