Comparison of transperineal and transabdominal ultrasound in the assessment of voluntary pelvic floor muscle contractions and functional manoeuvres in continent and incontinent women

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.     

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.     

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.     

Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements

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.     

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.     

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.     

Assessment of pelvic floor muscle contraction in stress urinary incontinent women: comparison between transabdominal ultrasound and perineometry

Introduction and hypothesis  

Transabdominal (TA) ultrasound and perineometry have been currently used to assess lifting aspect and squeezing action of pelvic floor muscles (PFM) function, respectively, in women with stress urinary incontinence (SUI). However, no study has directly compared these measurements. The purpose of this study was to investigate the reliability and correlation between perineometry and TA ultrasound as measurements of different aspect of PFM function.     

Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction

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.     

The assessment of levator trauma: a comparison between palpation and 4D pelvic floor ultrasound

AIMS: Major morphological abnormalities of the pubovisceral muscle are observed in 10-20% of women symptomatic of pelvic floor disorders. Such defects arise in childbirth and are associated with prolapse. While they are clearly evident on 3D ultrasound and MR imaging, such defects can be difficult to detect clinically. We intended to compare findings on palpation with the results of ultrasound imaging. MATERIAL AND METHODS: Fifty-five women were recruited in a prospective observational study and assessed by interview, vaginal examination by a trained pelvic floor physiotherapist, and 3D/4D pelvic floor ultrasound. The vaginal examination involved digital assessment of muscle strength (modified Oxford grading) and morphological abnormalities. The ultrasound examination involved acquisition of volume datasets taken at rest, on Valsalva and pelvic floor muscle contraction. Assessments were undertaken supine and after voiding. Ultrasound operator and physiotherapist were blind to each other's findings. RESULTS: A comparison of 3D ultrasound and palpation was possible in 54 cases. Average Oxford grading was weakly associated with reduction in hiatal dimensions on contraction (r = -0.32, P = 0.024). A marked increase in hiatal dimensions detected on palpation was associated with increased hiatal area on Valsalva (P = 0.027). Defects were observed in 7/54 (13%) on ultrasound and in 10/55 (18%) on palpation. There was poor agreement between the methods, with only two defects picked up equally by both methods. CONCLUSIONS: Palpation of the pubovisceral muscle correlates poorly with 3D/4D pelvic floor ultrasound imaging for the assessment of muscular defects.     

Test–retest reliability of internal pudendal artery blood flow using color Doppler ultrasound in healthy women

Introduction and hypothesis

The internal pudendal artery (IPA) is one of the main arteries supplying the pelvic floor muscles (PFMs) and vulvo-vaginal tissues. Its assessment with color Doppler ultrasound has been documented previously, but the reliability of IPA measurements has never been assessed. This study evaluates the test–retest reliability of IPA blood flow parameters measured by color Doppler ultrasound under two conditions: at rest and after a PFM contraction task.

Methods

Twenty healthy women participated in this study. One observer performed two measurement sessions using a clinical ultrasound system with a curved-array probe on the participant’s gluteal area. IPA measurements were repeated: at rest and after a PFM contraction task. Peak systolic velocity (PSV), time-averaged maximum velocity (TAMX), end-diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) were measured. Test–retest reliability was assessed using a paired t test, intraclass correlation coefficient (ICC), and Bland and Altman plots.

Results

There was no significant difference for all IPA blood flow measurements between the two repeated sessions. At rest, reliability was excellent for PSV and TAMX and the variability between measurements, as per Bland and Altman plots, was small. After PFM contractions, reliability was excellent for PSV and TAMX and fair to good for PI. The variability between measurements was small for PSV and acceptable for TAMX and PI. EDV and RI parameters did not perform as well.

Conclusion

The assessment of IPA blood flow with color Doppler ultrasound to evaluate vascular change in women is reliable.

     

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.     

The Urethral Pressure Profile and Ultrasound Imaging of the Lower Urinary Tract

In a prospective study 105 patients with symptoms of stress incontinence underwent videourodynamic testing, including resting urethral pressure profilometry and translabial ultrasound. The urethral pressure profile (UPP) included maximum urethral closure pressure (MUCP), functional length (FL) and area under the curve (AUC). Ultrasound parameters included urethral thickness, urethral rotation and bladder neck descent, as well as funneling/opening of the internal urethral meatus on Valsalva maneuver. Levator contraction strength was assessed measuring the cranioventral displacement of the internal meatus. Negative correlations between UPP data and age, parity and previous surgery were observed which were consistent with literature data. There was a positive correlation between the urethral AP diameter on ultrasound and the MUCP, which agrees with reports showing reduced sphincter thickness or volume in stress-incontinent women. Hypermobility on ultrasound did not correlate with UPP data. However, a lower MUCP correlated with extensive opening of the bladder neck. Finally, there was a trend towards poorer pelvic floor function with lower MUCP measurements.     

Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review

Transabdominal ultrasound was used to assess 104 women with incontinence and prolapse. The bladder was used as a marker of levator plate (LP) movement. The women were asked to draw in and lift the pelvic floor muscles (PFM) and a change in position of the LP in a cranial or caudal direction during contraction was documented. Three different patterns of movement of the LP were identified, with 38% of subjects elevating and 43% of subjects depressing the LP; 19% had no change in LP movement. In the stress incontinence group there was a higher than expected number that elevated the LP. In the urgency and prolapse groups there was a higher than expected number of subjects that depressed the LP ( P=0.008).The results highlight three different subgroups based on the patients' attempt to initiate elevation of the LP. Subjects who depressed the LP when instructed to elevate it appeared to adopt straining strategies via the generation of intra-abdominal pressure. Depression of the LP may have long-term negative implications for prolapse and incontinence.     

A Pilates exercise program with pelvic floor muscle contraction: Is it effective for pregnant women? A randomized controlled trial

Aims

The aim of this study was to evaluate the effectiveness of a Pilates exercise program with pelvic floor muscle (PFM) contraction compared to a conventional intervention in pregnant women.

Methods

Fifty primiparous women, without gestational alterations, were randomized to the Pilates group (n = 25) and control group (n = 25). Interventions for both groups consisted of twice‐weekly sessions of 1 h each during the period between the 14‐16th and 32‐34th gestational weeks. The Pilates group performed a Pilates exercises program with the addition of voluntary PFM contraction. Mat‐based Pilates exercises were performed involving movement of the upper limbs, lower limbs and trunk in all sessions. The Control group walked for 10 min and performed strengthening exercises of the lower limbs, upper limbs, and trunk with resistance from an elastic band and body weight. Each woman was evaluated by an unblinded physiotherapist before and after intervention for primary (PFM strength using a manometer) and secondary (PFM strength using Oxford Scale, endurance and repeatability) outcomes. Covariance analysis (ANCOVA) was used to compare the groups using the baseline values as a covariate.

Results

Thirty‐six women were included in the analysis. There were no differences between the groups for manometry. An increase in the PFM strength, endurance, and repeatability was only observed in the Pilates group. In addition, the Pilates group showed greater adherence to the intervention.

Conclusion

Pilates exercise program with PFM contraction is not able to change the PFM strength assessed by manometer in pregnant women, but it improved adherence to the intervention.     

经会阴三维超声评价女性盆底肌肉形态及功能

目的应用经会阴三维超声测量年轻未育女性的耻骨内脏肌宽度及肛提肌裂孔大小,探讨女性盆底的形态及功能。方法对100例18～31岁年轻未育女性在安静状态下、最大瓦氏动作及提肛动作时采集盆底经会阴三维超声图像,脱机分析,分别测量肛提肌裂孔的前后径、左右径、面积及耻骨内脏肌的宽度,并通过计算组内相关系数评估观察者之间的一致性。结果肛提肌裂孔呈菱形,两侧耻骨内脏肌基本对称,呈带状高回声,在肛直肠角后方形成U型襻。安静状态下肛提肌裂孔面积(11.15±1.70)cm2,最大瓦氏动作时增大至(14.35±2.43)cm2,而提肛动作时缩小至(9.20±1.46)cm2。两名观察者测量安静状态及提肛动作时的肛提肌裂孔大小及不同状态下耻骨内脏肌宽度一致性较好,但在最大瓦氏动作时测量肛提肌裂孔大小的一致性稍差。结论经会阴三维超声能直观观察盆底耻骨内脏肌的宽度及肛提肌裂孔的动态变化。     

Test–retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function

The aims of the present study were to evaluate test–retest intra-observer repeatability of ultrasound measurement of the morphology and function of the pelvic floor muscles (PFMs). Seventeen subjects were tested twice. Two-, three- and four- dimensional ultrasound recorded cough, huff, muscle morphology and PFM contraction, respectively. Analyses were conducted offline. Measurements of levator hiatal dimensions demonstrated intra-class correlation coefficient (ICC) values of 0.61, 0.72, 0.86 and 0.92, for the anterior-posterior dimension, transverse dimension, resting area and narrowing during contraction, respectively. Muscle thickness showed variable reliability. ICC values for measurement of the position of the bladder neck were 0.86 and 0.82 at rest, in the vertical and horizontal direction. Displacement of the bladder neck during contraction, huff and cough demonstrated ICC values of 0.56, 0.59 and 0.51, respectively. Perineal ultrasound is a reliable method for measuring most of the tested parameters of morphology and function of the PFMs.     

Review of current status of female sexual dysfunction evaluation in urogynecology

A new theory claims that the pelvic floor muscles (PFM) can be trained via the transversus abdominis (TrA). The aim of the present study was to compare the effect of instruction of PFM and TrA contraction on constriction of the levator hiatus, using 4D perineal ultrasonography. Thirteen women with pelvic organ prolapse participated in the study. Perineal ultrasound in standing position was used to assess constriction of the levator hiatus. Analyses were conducted off-line with measurements in the axial plane of minimal hiatal dimensions. The reduction of all the hiatal dimensions was significantly greater during PFM than TrA contraction. All patients had a reduction of the levator hiatus area during PFM contraction (mean reduction 24.0%; range 6.1–49.2%). In two patients, there was an increase of the levator hiatus area during TrA contraction. Instruction of PFM contraction is more effective than TrA contraction. An abstract containing these results is accepted as a discussion poster to be presented at the ICS Annual Meeting in Cairo, October 2008.     

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.     

Revisiting reliability of quantified perineal ultrasound: Bland and Altman analysis of a new protocol for the rectangular coordinate method

AIMS: This study tested the reliability of a new protocol for the rectangular coordinate method of quantifying perineal ultrasound. METHODS: Representative scans of healthy primiparous females were quantified by positioning a pubic bone template, drawn onto an acetate sheet containing x-y axes, over scans, by aligning the x-axis with the pubic bone central axis. Values for x (D(x)) and y (D(y)) located the urethrovesical junction (UVJ) at Rest, and at maximal Valsalva and Kegel. Range of motion (V-K) was calculated. Bland and Altman analysis, correlations, and t-tests determined intra- and inter-rater reliability, and variance due to designation of the pubic bone central axis (template control). RESULTS: Correlations averaged 0.72, 0.70, and 0.92 for intra-rater, inter-rater, and template control experiments. D(x) Rest, D(x) Kegel, and V-K were reliable in all experiments. First and second measures for inter-rater D(y) Rest and D(y) Kegel, and template control D(y) Valsalva were significantly different. Bland and Altman analysis showed D(y) Rest, D(y) Kegel, and D(x) and D(y) Valsalva for both reliability experiments to have limits of agreement (LOA's) large enough to explain >or=50% of the actual value ranges. Template control LOA's explained 相似文献   

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.