Relationship between abdominal and pelvic floor muscle activation and intravaginal pressure during pelvic floor muscle contractions in healthy continent women

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.     

Differences in muscle activation patterns during pelvic floor muscle contraction and Valsalva maneuver

AIMS: To investigate the different muscle activation patterns around the abdomino-pelvic cavity in continent women and their effect on pressure generation during a correct pelvic floor muscle (PFM) contraction and a Valsalva maneuver. METHODS: Thirteen continent women were assessed. Abdominal, chest wall, and PFM activity and vaginal and intra-abdominal pressure (IAP), were recorded during two tasks: PFM contraction and Valsalva whilst bladder base position was monitored on trans-abdominal ultrasound. A correct PFM contraction was defined as one that resulted in bladder base elevation and a Valsalva resulted in bladder base depression. RESULTS: Comparison of the mean of the normalized EMG activity of all the individual muscle groups was significantly different between PFM contraction and Valsalva (P = 0.04). During a correct PFM contraction, the PFM were more active than during Valsalva (P = 0.001). During Valsalva, all the abdominal muscles (IO (P = 0.006), EO (P < 0.001), RA (P = 0.011)), and the chest wall (P < 0.001) were more active than during PFM contraction. The change in IAP was greater during Valsalva (P = 0.001) but there was no difference in the change in vaginal pressure between PFM contraction and Valsalva (P = 0.971). CONCLUSIONS: This study demonstrates a difference in muscle activation patterns between a correct PFM contraction and Valsalva maneuver. It is important to include assessment of the abdominal wall, chest wall, and respiration in the clinical evaluation of women performing PFM exercises as abdominal wall bracing combined with an increase in chest wall activity may cause rises in IAP and PFM descent.     

Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and Valsalva manouevre

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.     

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: I. Reliability of vaginal pressure measurements of pelvic floor muscle strength

The reliability of measurements of pelvic floor muscle strength using a vaginal balloon catheter connected to a pressure transducer was tested in 28 healthy women, mean age 32.3 years (21–50). Fourteen women (group 1) performed three pelvic floor muscle contractions in three series with reinstallation of the balloon catheter to the same vaginal position between each series. Additionally, retest was done after a period of 2 weeks. Reproducibility of the results was tested in another similar group of 14 women (group 2) who did a 1 day test. In the first group the maximum contraction value (resting pressure not included) varied from 5 to 40 cm H₂O. However, the median difference value of the three series tested on two different days was only 3, 1, and 1 cm H₂O, respectively. The two groups of women demonstrated similar values of vaginal pressure measurements. Thus, a balloon with a given vaginal position for measurements of pelvic floor muscle strength gives reliable pressure recordings.     

Pressure measurements during pelvic floor muscle contractions: The effect of different positions of the vaginal measuring device

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.     

Women with SUI demonstrate motor control differences during voluntary pelvic floor muscle contractions

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.     

Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation

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.     

Evaluation of Pelvic Floor Muscle Strength Using Four Different Techniques

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.     

Postural and respiratory functions of the pelvic floor muscles

AIMS: Due to their contribution to modulation of intra-abdominal pressure (IAP) and stiffness of the sacroiliac joints, the pelvic floor muscles (PFM) have been argued to provide a contribution to control of the lumbar spine and pelvis. Furthermore, as IAP is modulated during respiration this is likely to be accompanied by changes in PFM activity. METHODS: In order to evaluate the postural and respiratory function of the PFM, recordings of anal and vaginal electromyographic activity (EMG) were made with surface electrodes during single and repetitive arm movements that challenge the stability of the spine. EMG recordings were also made during respiratory tasks: quiet breathing and breathing with increased dead-space to induce hypercapnoea. RESULTS: EMG activity of the PFM was increased in advance of deltoid muscle activity as a component of the pre-programmed anticipatory postural activity. This activity was independent of the direction of arm movement. During repetitive movements, PFM EMG was tonic with phasic bursts at the frequency of arm movement. This activity was related to the peak acceleration of the arm, and therefore the amplitude of the reactive forces imposed on the spine. Respiratory activity was observed for the anal and vaginal EMG and was primarily expiratory. When subjects moved the arm repetitively while breathing, PFM EMG was primarily modulated in association with arm movement with little respiratory modulation. CONCLUSIONS: This study provides evidence that the PFM contribute to both postural and respiratory functions.     

Transabdominal ultrasound measurement of pelvic floor muscle activity when activated directly or via a transversus abdominis muscle contraction

AIMS: The purpose of the present study was to compare the effectiveness of instruction to contract the pelvic floor muscles (PFM), the transversus abdominis (TrA), and the TrA + PFM visualized as displacement of the pelvic floor by ultrasound. MATERIALS AND METHODS: Twenty female physical therapists, mean age 41.1 years (range 26-56) participated in the study. A 3.5 MHz 35 mm curved linear array ultrasound transducer (Dornier Medtech) was placed in the mid-sagittal plane immediately suprapubically, angled at 15-30 degrees from the vertical depending on subcutaneous fat and anatomical variations, to image the pelvic floor. Six trials of three maneuvers in random order were performed: contraction of PFM, TrA, and TrA + PFM. RESULTS: In spite of correct contractions assessed by palpation and clinical observation, one subject demonstrated a downward movement of the pelvic floor during PFM contraction on ultrasound. Six subjects (30%) showed a downward movement during a TrA- contraction, and two during the combined TrA + PFM contraction. Instruction to contract PFM produced significantly greater mean displacement: 11.2 mm (95% CI 7.2-15.3) than TrA 4.3 mm (95% CI -0.2-8.8), P < 0.01, and combination: 8.5 mm (95% CI 5.2-12), P = 0.04. Hence, instruction of PFM contraction produced a 61.6% greater displacement of the pelvic floor in the correct direction than a TrA contraction. CONCLUSIONS: It is concluded that ultrasound is a more valid method than palpation and clinical observation to assess PFM function, and that instruction to contract the PFM produces a significantly more effective pelvic floor muscle contraction than instruction to perform a TrA contraction.     

Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements

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.     

Effect of abdominal and pelvic floor tasks on muscle activity, abdominal pressure and bladder neck

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.     

Reliability of pelvic floor muscle strength measurement in elderly incontinent women

Pelvic floor muscles (PFM) play an important role in maintaining urinary continence with increasing age. Therefore, their contractile properties need to be evaluated. The aim of the study was to examine the reliability and correlation of simple techniques to measure PFM strength in elderly women with urinary incontinence. An interview was used to evaluate the ability to stop the urinary stream during micturition and to calculate the incontinence index. A pad test was applied to objectively evaluate the severity of the disease. Functional testing included a digital examination to measure the force and duration of one contraction, a perineometer measurement (Peritron) to assess maximal contraction force and contraction force of 5 s, and a cone-retention test (Femcon) while walking for 1 min and during Valsalva's manoeuvre. This procedure was performed on three separate occasions within one week. The 37 participating women with a mean age of 62+/-8 (mean+/-SD) years had a severity index of 4.4+/-2.6 and a urine loss of 9.5+/-13.6 mg during the pad test. Sixteen women were able to completely stop the urinary stream during micturition. The digital examination showed no intratester variability. The perineometer measurement showed that the absolute difference in maximal contraction force and mean contraction force within 5 s was less than 5.3 mm Hg and 4.5 mm Hg, respectively, with a probability of 0.95. While walking and during Valsalva's manoeuvre, 19 and 20 women, respectively, held the same cone in place on all three occasions. The maximal contraction force and mean force during the 5-s contraction correlated well with the ability to stop the urinary stream and the digital examination but only weakly with the cone-retention tests. The reliability of PFM strength measurement is highest in the digital examination, followed by perineometer measurements, and then by vaginal cone tests. As PFM function is easy to assess, it should be routinely done in the assessment of urinary incontinence in elderly women.     

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises

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.     

The effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence

The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. A prospective comparison design of 99 matched pairs (n=198) of mothers, a training group and a control group, was used. Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course, training in groups led by a physical therapist for 45 minutes once a week. In addition they were asked to exercise at home at least three times per week. The control group followed the ordinary written postpartum instructions from the hospital. Pelvic floor muscle strength was measured pretreatment at the eighth, and post-treatment at the 16th week after delivery, using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction. Urinary leakage was registered by interview, specially designed instruments to measure how women perceive SUI, and a standardized pad test. At baseline (8 weeks postpartum) there was no significant difference in the number of women with urinary incontinence in the training group compared to the control group. At 16 weeks postpartum, after the 8-week treatment period, there was a significant (P<0.01) difference in favor of the training group. In addition, a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group. The results show that a specially designed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period. EDITORIAL COMMENT: This paper is one of only a few looking at the efficacy of a rigorous pelvic floor muscle exercise training regime to help women with incontinence in the postpartum period. Whether or not these results will translate long-term into a lower incidence of urinary incontinence as these women age, is unknown, and may never be known. However, this paper points out that there is a definite benefit from pelvic floor muscle exercise for the treatment of postpartum incontinence, and we can use this information to more strongly counsel our patients in the use of these exercises.     

Electromyographic evaluation of pelvic floor muscles in pregnant and nonpregnant women

Introduction and hypothesis

We compared the maximal voluntary contraction (MVC) and strength of pelvic floor muscles (PFM) of pregnant and nonpregnant women using surface electromyography (SEMG).

Methods

Fifteen pregnant primiparous women and 15 nulliparous nonpregnant women were evaluated. The healthy pregnant women were in the third trimester of pregnancy with a single fetus and did not have any neuromuscular alterations. The nonpregnant women did not present with PF dysfunctions and, as with the pregnant women, did not have any previous gynecological surgeries or degenerative neuromuscular alterations. The evaluation methods used were digital palpation (Oxford Grading Scale, which ranges from 0 to 5) and SEMG. In the EMG exam, MVC activity was evaluated, and the better of two contractions was chosen. Before the evaluation, all women received information about PFM localization and function and how to correctly contract PFM.

Results

In the EMG evaluation, MVC was significantly greater in the nonpregnant group (90.7 μv) than in the pregnant group (30 μv), with p?p?=?0.005).

Conclusion

In comparison to nulliparous women, pregnant women demonstrated worse PFM function with decreased strength and electrical activity.     

Reliability of speed of contraction and endurance dynamometric measurements of the pelvic floor musculature in stress incontinent parous women

AIMS: To evaluate the test-retest reliability of dynamometric measurements of the pelvic floor muscles (PFM) during speed and endurance tests. METHODS: Nineteen parous women suffering from stress urinary incontinence (SUI) participated in the study. Two PFM evaluation sessions were conducted using the dynamometric speculum. For the speed test, the women were instructed to contract maximally and relax as quickly as possible during a 15-s test period. The speed of contraction was quantified by the rate of force development of the first contraction and the number of contractions performed. The maximal strength value attained during the speed test was also extracted from the curves. For the endurance test, the subjects were asked to maintain a maximal contraction for 90 s. The normalized area under the force curve was utilized as the endurance parameter. The reliability of the data was evaluated using the generalizability theory. Two reliability estimates were calculated, the dependability indices (Phi) and the standard error of measurement (SEM), for one measurement session involving one trial. RESULTS: The indices of dependability obtained indicate that the reliability of the speed of contraction and endurance parameters are good (Phi=0.79-0.92). The corresponding SEMs were 1.39 N/s, 1 contraction, 1.00 N, and 298%*s for the rate of force development, number of contractions, maximal strength and normalized area, respectively. CONCLUSION: This study indicates that the speed of contraction and endurance parameters possess good test-retest reliability. The inclusion of these parameters in the PFM assessment is therefore highly recommended for assessing changes in PFM in incontinent women.     

Can maximal voluntary pelvic floor muscle contraction reduce vaginal resting pressure and resting EMG activity?

Introduction and hypothesis

The purpose of the present study was to assess whether attempts at a maximal voluntary pelvic floor muscle (PFM) contraction can reduce vaginal resting pressure (VRP) and surface EMG activity in women with and without provoked vestibulodynia (PVD).

Method

An assessor blinded comparison study included 35 women with and 35 women without PVD. VRP and PFM strength were measured with a high precision pressure transducer connected to a vaginal balloon (Camtech AS, Sandvika Norway). PFM activity was measured before and after three MVCs with surface EMG (NeuroTrac ETS?; Verity Medical, Romsey, UK). Paired sample t test was used to analyze differences within groups and independent sample t test to analyze differences between groups. p value was set at <0.05.

Results

Mean age of the participants was 24.3 years (SD 4.7) and mean BMI was 22.0 kg/m² (SD 2.6). There were no significant differences between the groups in any background variables. PFM contraction led to a statistically significant reduction of VRP in both the PVD (p?=?0.001) and the control group (p?=?0.027). Surface EMG activity was significantly reduced in the PVD group only (p?=?0.001).

Discussion

Young, nulliparous women with PVD had significantly lower vaginal resting pressure and sEMG activity after three maximum contractions of the PFM. The results indicate that attempts at voluntary maximal contractions may be investigated as a method of reducing PFM hypertonicity.

     

Needle emg registration of striated urethral wall and pelvic floor muscle activity patterns during cough,valsalva, abdominal,hip adductor,and gluteal muscle contractions in nulliparous healthy females

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.     

Pelvic floor muscle function in women with pelvic floor dysfunction

Introduction and hypothesis

The objectives of this study were to investigate the level of pelvic floor muscle (PFM) function in women with pelvic floor dysfunction (PFD) referred by gynaecologists and urologists for in-hospital pelvic floor muscle training (PFMT), and to identity associated factors for a low level of PFM function.

Methods

Data of women with PFD referred to a PFMT programme were included in a retrospective chart review. Measurement of PFM function performed by digital vaginal palpation included: voluntary PFM contraction, PFM strength (Modified Oxford Grading Scale) and PFM static endurance.

Results

Data of 998 women, mean age 56 (SD 13) years, with PFD (urinary incontinence, n?=?757, anal incontinence, n?=?36, pelvic organ prolapse, n?=?111, other PFD, n?=?94) were analysed. In all, 690 women (70 %) were, at baseline, unable to perform correct voluntary PFM contraction, mean PFM strength was 1.5 (SD 1.0) points, mean PFM static endurance was 16.7 (SD 16.1) seconds. Age ≥ 65 years and year of referral > 2000 were significantly (p?< 0.01) associated with the ability to perform correct PFM contraction. Likewise, year of referral was significantly associated with high PFM strength (p?< 0.01).

Conclusions

The majority of the women were unable to perform correct voluntary PFM contraction and almost all had low PFM strength. The most important factor associated with a low level of PFM function was age.