scholarly journals Mechanisms governing protective pregnancy-induced adaptions of the pelvic floor muscles in the rat pre-clinical model

2021 ◽  
Author(s):  
Mary M Rieger ◽  
Michelle Wong ◽  
Lindsey A Burnett ◽  
Francesca Boscolo Sesillo ◽  
Brittni Baynes ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Mechanical Load ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Muscles ◽  
Collagen Content ◽  
Gravid Uterus ◽  
Sustained Load ◽  
Birth Injury ◽  
Induced Changes ◽  
Pregnancy Hormones

Background: The intrinsic properties of pelvic soft tissues in women who do and do not sustain birth injuries are likely divergent, however little is known about this. Rat pelvic floor muscles undergo protective pregnancy-induced structural adaptations, sarcomerogenesis and increase in intramuscular collagen content, that protect against birth injury. Objectives: We aimed to test the following hypotheses: 1) increased mechanical load of gravid uterus drives antepartum adaptations; 2) load-induced changes are sufficient to protect pelvic muscles from birth injury. Study Design: Independent effects of load uncoupled from hormonal milieu of pregnancy were tested in 3- to 4-month-old Sprague-Dawley rats randomly divided into four groups, N=5-10/group: (1) load-/pregnancy hormones- (controls); (2) load+/pregnancy hormones-; (3) reduced load/pregnancy hormones+; (4) load+/pregnancy hormones+. Mechanical load simulating a gravid uterus was simulated by weighing uterine horns with beads similar to fetal rat size and weight. Reduced load was achieved by unilateral pregnancy after unilateral uterine horn ligation. To assess acute and chronic phases required for sarcomerogenesis, rats were sacrificed at 4 hours or 21 days post bead loading. Coccygeus, iliocaudalis, pubocaudalis and non-pelvic tibialis anterior were harvested for myofiber and sarcomere length measurements. Intramuscular collagen content was assessed using hydroxyproline assay. Additional 20 load+/pregnancy hormones- rats underwent vaginal distention to determine whether load-induced changes are sufficient to protect from mechanical muscle injury in response to parturition-associated strains of various magnitude. Data, compared using two-way repeated measures analysis of variance/pairwise comparisons, are presented as mean +/- standard error of mean. Results: Acute increase in load resulted in significant pelvic floor muscle stretch, accompanied by acute increase in sarcomere length compared to non-loaded control muscles (coccygeus: 2.69+/-0.03 vs 2.30+/-0.06 micrometers, P<0.001; pubocaudalis: 2.71+/-0.04 vs 2.25+/-0.03 micrometers, P<0.0001; iliocaudalis: 2.80+/-0.06 vs 2.35+/-0.04 micrometers, P<0.0001). After 21 days of sustained load, sarcomeres returned to operational length in all pelvic muscles (P>0.05). However, the myofibers remained significantly longer in load+/pregnancy hormones- compared to load-/pregnancy hormones- in coccygeus (13.33+/-0.94 vs 9.97+/-0.26 millimeters, P<0.0001) and pubocaudalis (21.20+/-0.52 vs 19.52+/-0.34 millimeters, P<0.04) and not different from load+/pregnancy hormones+ (12.82+/-0.30 and 22.53+/-0.32millimeters, respectively, P>0.1), indicating that sustained load induced sarcomerogenesis in these muscles. Intramuscular collagen content in load+/pregnancy hormones- group was significantly greater relative to controls in coccygeus (6.55+/-0.85 vs 3.11+/-0.47 micrograms/milligram, P<0.001) and pubocaudalis (5.93+/-0.79 vs 3.46+/-0.52 micrograms/milligram, P<0.05) and not different from load+/pregnancy hormones+ (7.45+/-0.65 and 6.05+/-0.62 micrograms/milligram, respectively, P>0.5). Iliocaudalis required both mechanical and endocrine cues for sarcomerogenesis. Tibialis anterior was not affected by mechanical or endocrine alterations. Despite equivalent extent of adaptations, load-induced changes were only partially protective against sarcomere hyperelongation. Conclusions: Load induces plasticity of the intrinsic pelvic floor muscle components that renders protection against mechanical birth injury. The protective effect, which varies between individual muscles and strain magnitudes, is further augmented by the presence of pregnancy hormones. Maximizing impact of mechanical load on pelvic floor muscles during pregnancy, such as with specialized pelvic floor muscle stretching regimens, is a potentially actionable target for augmenting pregnancy-induced adaptations to decrease birth injury in women who may otherwise have incomplete antepartum muscle adaptations.

2. VAGINISMUS, VULVODYNIA AND PELVIC FLOOR MUSCLE ACTIVITY

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 285
Author(s):  
R. Sapsford
Keyword(s):  
Pelvic Floor ◽  
Muscle Activity ◽  
Pelvic Floor Muscle ◽  
Normal Function ◽  
Pelvic Floor Muscles ◽  
Abdominal Pressure ◽  
Abdominal Muscles ◽  
Physiological Factors ◽  
Muscle Groups ◽  
Postural Support

The pelvic floor muscles form the base of the abdominal cylinder and work in synergy with other muscles around the cylinder - the abdominal muscles and the diaphragm. Activity in each muscle group affects the others. Coordinated recruitment of these muscle groups is necessary for generation and maintenance of intra-abdominal pressure, postural support of the trunk, and during functional tasks such as lifting, coughing and nose blowing. Coordinated release of these groups is required for micturition, while defaecation may need activity in some muscles and release in others. Vaginismus and vulvodynia both have a component of over activity of the pelvic floor muscles which impairs normal function, though this over activity may only occur at the time of attempted penetration. Some of the physiological factors that contribute to this overactivity come from outside the pelvic floor muscle complex itself and can be ameliorated by understanding and management of these muscle synergies. An EMG study of muscle activity of the abdominal and pelvic floor muscles during a simulated body posturing for female sexual arousal will help to explain how the pelvic floor muscle over activity in vaginismus arises. Treatment programmes that have been used to successfully address these problems will be explained.

Biofeedback for Pelvic Muscle Dysfunction

Biofeedback ◽  
2016 ◽  
Vol 44 (2) ◽  
pp. 55-57
Author(s):  
Debbie Callif
Keyword(s):  
Pelvic Floor ◽  
Pelvic Pain ◽  
Control Strategies ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Bowel Function ◽  
Pelvic Floor Muscles ◽  
Muscle Dysfunction ◽  
Reduction Techniques ◽  
Obturator Internus

Biofeedback for pelvic floor muscle dysfunction provides a practical and effective intervention for elimination disorders. Dysfunction in the pelvic floor muscles can affect bladder and bowel function and can cause pelvic pain. According to the National Association of Continence, there are 25 million Americans affected by bladder or bowel incontinence. Surface electromyographic (sEMG) sensors monitor the electrical activity of the pelvic floor muscles. Additional muscle co-contractions of the obturator internus, hip adductors, and transverse abdominis can facilitate improvements in symptoms affected by pelvic floor dysfunction. Pelvic floor therapy incorporates urge reduction techniques and functional control strategies. Dietary and lifestyle recommendations are also provided. The Biofeedback Certification International Alliance (BCIA) is the primary certifying body in the fields of biofeedback and neurofeedback. BCIA has a Blueprint of Knowledge specific for certification in pelvic muscle dysfunction biofeedback (PMDB). The Blueprint outlines the fundamental science, history, and theory of sEMG biofeedback as used for elimination disorders and chronic pelvic pain. You can find more information on PMDB at www.bcia.org.

scholarly journals Effect of Postpartum Pelvic Floor Muscles Training in Pelvic Floor Muscles Strength on Postpartum Women with Stress Urinary Incontinence

2018 ◽  
pp. 114
Author(s):  
Jerisatrio S Tarukallo ◽  
David Lotisna ◽  
Nugraha U Pelupessy
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Muscles ◽  
P Value ◽  
Postpartum Women ◽  
Perineal Tear ◽  
International Consultation ◽  
Pelvic Floor Training ◽  
Significant Difference ◽  
Pelvic Muscles

Objective: To evaluate the effect of pelvic floor training (Kegelexercise) on pelvic floor muscle strength in postpartum womenwith SUI.Methods: Thirty-five birth vaginally postpartum women with SUIwere experimentally enrolled. After four weeks of postpartumobservation, the diagnosis of SUI confirmed, and all of these womenwere asked to complete the International Consultation onIncontinence Questionnaire-Sort Form (ICIQ-SF) questionnaire.The strength of the pelvic floor muscle measured with perineometerevery once in 3 weeks for 12 weeks of Kegel exercise. SUI severityassessed with ICIQ-SF after completing the Kegel exercise. A pairedt-test was used to compare measurement results between ICIQ-SFquestionnaire and perineometer and multiple linear regressionmodels was used for multivariate analysis. A p value of less than 0.05was taken to be statistically significant.Results: Findings show a significant difference between clinicalvariables (parity, neonates birth weight, perineal tear grade, BMI)and the improvement of pelvic floor muscles before and afterperformed the Kegel exercise (all p<0.05). The pelvic floormuscles strength significantly improved (p=0.000) after Kegelexercise both in ICIQ-SF questionnaire and perineometermeasurement.Conclusion: Pelvic muscles floor training or Kegel exercise improvepelvic muscles floor strength in postpartum women with SUI.[Indones J Obstet Gynecol 2018; 6-2: 114-118]Keywords: pelvic muscles floor training, postpartum, stress urinaryincontinence

Pelvic floor muscle training in women with a history of breast cancer

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (1) ◽  
pp. 19-22
Author(s):  
Inna A Apolikhina ◽  
Valerii V Rodionov ◽  
Anna S Seialova ◽  
Aina S Saidova ◽  
Irina A Gukasian
Keyword(s):  
Breast Cancer ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle ◽  
Combined Treatment ◽  
Social Activity ◽  
Pelvic Floor Muscles ◽  
Prospective Clinical Study ◽  
Female Population ◽  
Surgical Interventions

Relevance. The issue of pelvic floor muscle dysfunction (PFMD) is common in female population. It causes severe moral suffering and reduces both social activity and a quality of patient’s life. In this regard PFMD management with modern methods for training of pelvic floor muscles using devices is the "first line" method. Aim. To study treatment effectiveness and a quality of life in women with PFMD followed radical treatment for breast cancer (BC). Outcomes and methods. A prospective clinical study on clinical efficacy of a biofeedback method in combination with electrical stimulation of pelvic floor muscles using a device “Urostim” in patients with mild PFMD followed combined treatment fpr BC was carried out at Department of Aesthetic Gynecology of V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology. The study included 15 postmenopausal women. Results. It was established that 10 sessions of pelvic floor muscles training in a mode of biofeedback result in beneficial effects on for all clinical indicators. Conclusion. PFMD treatment by training of pelvic floor muscles using devices is one of the most promising ways to reduce surgical interventions number in urogynecology and to provide a rehabilitation of women who had surgery for BC.

Effect of Kegel Exercises on Pelvic Floor Muscle Disorders in Prenatal and Postnatal Women - A Literature Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Eric Lawer Torgbenu ◽  
Christopher O. Aimakhu ◽  
Emmanuel Komla Senanu Morhe
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Muscles ◽  
Muscle Disorders ◽  
Kegel Exercises ◽  
Postnatal Women

Background: Pelvic floor disorders affect many women globally. Objective: To provide a critical appraisal of the literature on the effects of pelvic floor disorders on the quality of life and functioning of pregnant and postnatal women. Methods: Available literature was reviewed and summarized to discuss the definitions, pelvic floor anatomy, dysfunctions, and the mechanism of the condition, and more specifically, on the strengthening exercises for the pelvic floor muscles. Results: Pelvic floor disorder is an important public health concern because of the high prevalence, deleterious effects on pregnancy, and its outcomes as well as impacts on the health care system. They include genuine urinary incontinence, bladder and bowel incontinence, pelvic pain, weakness of the pelvic muscles, weakness of the muscles of the core stability, as well as the prolapse of pelvic organs. Pregnancy and subsequent vaginal delivery are associated causes of pelvic floor muscle disorders. Approximately 60% and 50% of community settlers and residents of nursing homes respectively are affected by urinary incontinence and the numbers increase with hysterectomy. Multiple birth, obesity, chronic coughs, overweight babies, and heavy lifting are associated risk factors. Treatment of pelvic floor muscle disorders should involve an increased physical activity prescription among women diagnosed with weaker pelvic floor muscles, engaging the multidisciplinary team, increasing the quality of life and functioning of women during and after pregnancy. Training aimed at strengthening the pelvic floor muscles is beneficial and prevention of dysfunctions. Conclusion: Structured and well organised pelvic floor muscle training regimen also known as Kegel exercises are important in preventing disorders of the pelvic floor during pregnancy and after delivery.

scholarly journals The Effects of a Progressive Exercise Program With Surface Electromyographic Biofeedback on an Adult With Fecal Incontinence

2002 ◽  
Vol 82 (8) ◽  
pp. 798-811 ◽  
Author(s):  
Stephanie Weiss Coffey ◽  
Elaine Wilder ◽  
Michael J Majsak ◽  
Renee Stolove ◽  
Lori Quinn
Keyword(s):  
Physical Therapy ◽  
Fecal Incontinence ◽  
Pelvic Floor ◽  
Relaxation Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Muscles ◽  
Vacuum Extraction ◽  
Physical Relationship ◽  
Electromyographic Biofeedback ◽  
Patient Reported

AbstractBackground and Purpose. Fecal incontinence often compromises a person's ability to participate in work and recreational activities. Incontinence may also diminish a person's willingness to take part in social events, leading to feelings of isolation. This case report describes physical therapy designed to reduce a patient's pelvic-floor muscle dysfunction and fecal incontinence. Case Description. The patient was a 30-year-old woman whose fecal incontinence began after the complicated vaginal birth of her first child that required a vacuum extraction and episiotomy. Intervention included soft tissue techniques, electromyographic biofeedback, strength training, relaxation training, patient education, and a home program. The patient completed a questionnaire at initial evaluation and at discharge to assess her perceived limitations in functional activities. Electromyographic analysis was used to measure changes in the patient's pelvic-floor muscle control. Outcomes. The social, occupational, and sexual domains, which the patient initially judged to be the most compromised, showed the greatest improvement. Electromyographic data for the final treatment session indicated improved strength, endurance, and control of her pelvic-floor muscles. The patient reported no episodes of fecal incontinence over the last month of the 3 months of therapy. Discussion. The physical therapy program may have led to improved bowel continence and greater control of the pelvic-floor muscles, resulting in greater confidence and comfort in social and work situations and less restriction in the patient's physical relationship with her spouse.

scholarly journals Reliability of Pelvic Floor Muscle Assessment with Transabdominal Ultrasound in Young Nulliparous Women

2021 ◽  
Vol 10 (15) ◽  
pp. 3449
Author(s):  
Bartosz Zając ◽  
Iwona Sulowska-Daszyk ◽  
Anna Mika ◽  
Artur Stolarczyk ◽  
Ewelina Rosłoniec ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Pelvic Floor Muscle ◽  
Ultrasound Image ◽  
Posterior Wall ◽  
Voluntary Contraction ◽  
Pelvic Floor Muscles ◽  
Quantitative Detection ◽  
Transabdominal Ultrasound ◽  
Nulliparous Women ◽  
The Right

The aim of this study was to assess the reliability of pelvic floor muscles evaluation via transabdominal ultrasonography in young nulliparous women and to present the methodology for quantitative assessment of the ultrasound image of the pelvic floor muscles visible as displacement of the posterior wall of the bladder, caused by action of the pelvic floor muscles. The study comprised 30 young, Caucasian, nulliparous women (age 22–27; 168.6 ± 5.1 cm; 57.1 ± 11.8 kg) without pelvic floor muscle dysfunctions. The intra-rater, test-retest and inter-rater reliability of pelvic floor muscles evaluation was performed using transabdominal ultrasound at rest and during voluntary contraction. The reliability was assessed at three points of the image (at the middle, on the right and left side). The reliability of the three-point measurement of the pelvic floor muscles transabdominal ultrasound is excellent in the case of intra-rater assessments, both at rest (ICC = 0.98–0.99) and during contraction (ICC = 0.97–0.98); moderate at rest (ICC = 0.54–0.62) and poor during contraction (ICC = 0.22–0.50) in the case of test–retest assessment; excellent at rest (ICC = 0.95–0.96), and good during contraction (ICC = 0.81–0.87) in the case of inter-rater assessment. Transabdominal ultrasound is a reliable method of pelvic floor muscle evaluation. The three-points of assessment used in our study allowed for broader and more comprehensive imaging of the pelvic floor muscle, e.g., for quantitative detection contractility imbalances between the left and right side Due to the fact that understanding mechanisms of pelvic floor muscle functioning is crucial in the therapy of pelvic floor dysfunctions, therefore, reliable, valid tests and instruments are important.

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