Effect of Pelvic Floor Muscle Electrical Stimulation on Lumbopelvic Control in Women With Stress Urinary Incontinence: Randomized Controlled Trial

Background: This study was performed to determine the effectiveness of 8 weeks of pelvic floor muscle (PFM) training by electrical stimulation (ES) on PFM function, lumbopelvic control, abdominal muscle thickness, and the contraction ratio in women with stress urinary incontinence (SUI). Methods: Women with SUI were randomized into an ES group (n = 18) or control group (n = 18). The ES group underwent a PFM ES training during 8-week, and the control group underwent only a general exercise without PFM training. PFM functions was measured using a perineometer. Lumbopelvic control was measured by one- and double-leg lowering tests. Abdominal muscle thickness and the contraction ratio during the active straight leg raise maneuver were measured by sonography. Results: The ES group showed significantly higher PFM strength and power than controls (p < 0.05) at after 8 weeks of training. PFM strength and power were significantly increased after 8 weeks of training in the ES group (p < 0.05). The ES group showed significantly higher values than the controls in both the one- and double-leg lowering tests (p < 0.05) at after 8 weeks of training. There were no significant between- or within-group differences, at rest or during contraction, in transverse abdominis (TrA), internal oblique abdominis (IO), or external oblique abdominis (EO) muscle thickness. Conclusion: Improvements in PFM functions by PFM ES could enhance lumbopelvic control in women with SUI.Trial registration: Clinical Research information Service, KCT0003357. Registered 11th November 2018 - Retrospectively registered, https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=12678&ltype=&rtype=

Effect of Aerobic Walking Exercise on Stress Urinary Incontinence in Postmenopausal Women

The purpose of this study was to explore the impact of aerobic walking exercise on stress urinary incontinence (SUI) among postmenopausal women. Thirty females diagnosed with SUI participated in the research. Participants were assigned randomly into two groups: The usual care group (UC) and the UC plus aerobic walking exercise (TMT) group. The UC group performed pelvic floor muscle (PFM) training only, while the TMT group performed PFM training in addition to aerobic exercise. Myomed biofeedback was used to assess the PFM strength both before and after a 12-week period. The Revised Urinary Incontinence Scale was utilized to assess changes in incontinence severity symptoms after intervention. Findings revealed a significant increase in PFM strength in both UC and TMT groups (p = .011 and p = .010, respectively) and a significant reduction in their Revised Urinary Incontinence Scale (p = .011 and p = .001, respectively) after the end of the 12 weeks of the training program. In addition, there was a more significant increase in PFM strength in the TMT group than in the UC group (p = .010) and a more significant decrease in Revised Urinary Incontinence Scale (p = .011) after 12 weeks of the training program. This study concluded that aerobic walking exercise with PFM training is more effective than PFM training only in increasing PFM strength and improving symptoms of SUI in postmenopausal women with SUI.

Effects of the Pilates method isolated and associated with manual therapy in women with urinary incontinence

Background: Urinary incontinence (UI) is clinically defined by the International Continence Society as involuntary urine loss. Currently, UI isconsidered a public health issue worldwide, considering that the prevalence in women is quite high, requiring attention from healthprofessionals. Objective: To evaluate the effects of the Pilates method associated with Manual Therapy in women with UI. Methods: It wasperformed a randomized, controlled, longitudinal clinical trial with a quantitative approach of the data. 14 female participants were evaluated,aged 20 to 55 years and who had presented episodes of urinary loss in the last months. The following evaluations were carried out: anamnesis,evaluation of urogynecological history, application of the King’s Health Questionnaire and PERFECT test. After all the evaluations, half of thevolunteers received treatment for urinary incontinence through a physical therapy approach that includes the Pilates method associated withManual Therapies (GPT), and the other half received treatment using only the Pilates method (GP). Results: Both groups showed increasedPFM strength, being GPT (p = 0.04) and GP (p = 0.00); increased resistance, being GPT (p = 0.02) and GP (p = 0.01); and the contraction offibers, being GPT (p = 0.04) and GP (p = 0.02). In the GPT there was a decrease in the severity measures (p = 0.01); disappearance ofnocturia (p = 0.04); decreased symptoms of SUI (p = 0.02); and bladder pain (p = 0.04). In the GP, there was a significant improvement in theperception of health (p = 0.00); decreased UI impact on the participant's life (p = 0.02); the influence of UI on emotions (p = 0.00); symptomsof overactive bladder (p = 0.01); and the SUI (p = 0.00). Conclusion: Both treatment protocols decrease episodes of leakage of urine whenthere is an increase in intra-abdominal pressure, increase the PFM strength, endurance and number of fast contractions, and the quality oflife of women with UI. However, only the group that received only the Pilates protocol showed an increase in repetitions of slow contraction.

Reliability and validity of pelvic floor muscle strength assessment using the MizCure perineometer

Background The purpose of this study was to clarify the reliability and validity of pelvic floor muscle (PFM) strength assessment using the MizCure perineometer in healthy women. Methods Twenty healthy women (age 20–45 years) participated in this study. The vaginal pressure measured using the MizCure and validated Peritron perineometers were repeated during PFM contraction in the supine and standing positions. All women were evaluated twice by examiners 1 and 2. Following the measurements in the first session (Test 1), they were repeated after an interval of between 2 and 6 weeks (Test 2). Within- and between-session intra- and inter-rater reliabilities in vaginal pressure were analyzed using intraclass correlation coefficients (ICC) (1, 1) and (2, 1), respectively. Validity was assessed by Pearson’s product-moment correlation coefficient and Spearman’s rank correlation analysis. Results Within-session intra-rater reliabilities for both examiners 1 and 2 for all vaginal pressures in Tests 1 and 2 were 0.90–0.96 for both perineometers. Between-session intra-rater reliability for the MizCure was 0.72–0.79 for both positions for examiner 1, and 0.63 in the supine position and 0.80 in the standing position for examiner 2. Inter-rater reliability for Test 1 was 0.91 in the supine position and 0.87 in the standing position for the MizCure. The vaginal pressures using the MizCure and Peritron were significantly associated with the supine position (r = 0.68, P < .001) and the standing position (rs = 0.82, P < .001). Conclusion MizCure perineometer is a validated tool to measure PFM strength in both supine and standing positions in healthy nulliparous women.

Reliability and Validity of Pelvic Floor Muscle Strength Assessment Using the MizCure Perineometer

Background: The purpose of this study was to clarify the reliability and validity of pelvic floor muscle (PFM) strength assessment using the MizCure perineometer in healthy women.Methods: Twenty healthy women (age 20-45 years) participated in this study. The vaginal pressure measured using the MizCure and validated Peritron perineometers were repeated during PFM contraction in the supine and standing positions. All women were evaluated twice by examiners 1 and 2. Following the measurements in the first session (Test 1), they were repeated after an interval of between 2 and 6 weeks (Test 2). Within- and between-session intra- and inter-rater reliabilities in vaginal pressure were analyzed using intraclass correlation coefficients (ICC) (1, 1) and (2, 1), respectively. Validity was assessed by Pearson’s product-moment correlation coefficient and Spearman’s rank correlation analysis.Results: Within-session intra-rater reliabilities for both examiners 1 and 2 for all vaginal pressures in Tests 1 and 2 were 0.90 to 0.96 for both perineometers. Between-session intra-rater reliability for the MizCure was 0.72 to 0.79 for both positions for examiner 1, and 0.63 in the supine position and 0.80 in the standing position for examiner 2. Inter-rater reliability for Test 1 was 0.91 in the supine position and 0.87 in the standing position for the MizCure. The vaginal pressures using the MizCure and Peritron were significantly associated with the supine position (r = 0.68, P < .001) and the standing position (rs = 0.82, P < .001).Conclusion: MizCure perineometer is a validated tool to measure PFM strength in both supine and standing positions in healthy nulliparous women.

Reliability and Validity of Pelvic Floor Muscle Strength Assessment Using the MizCure Perineometer

Background The purpose of this study was to clarify the reliability and validity of pelvic floor muscle (PFM) strength assessment using the MizCure perineometer in healthy women. Methods Twenty healthy women (age 20–45 years) participated in this study. The vaginal pressure measurements using the MizCure and Peritron perineometers were repeated during PFM contraction in the supine and standing positions. All women were evaluated twice by examiners 1 and 2. Following the measurements in the first session (Test 1), they were repeated after an interval of between 2 and 6 weeks (Test 2). Within- and between-session intra- and inter-rater reliabilities in vaginal pressure were analyzed using intraclass correlation coefficients (ICC) (1, 1) and (2, 1), respectively. Validity was assessed by Pearson’s product-moment correlation coefficient and Spearman’s rank correlation analysis. Results Within-session intra-rater reliabilities for both examiners 1 and 2 for all vaginal pressures in Tests 1 and 2 were 0.90 to 0.96 for both perineometers. Between-session intra-rater reliability for the MizCure was 0.72 to 0.79 for both positions for examiner 1, and 0.63 in the supine position and 0.80 in the standing position for examiner 2. Inter-rater reliability for Test 1 was 0.91 in the supine position and 0.87 in the standing position for the MizCure. The vaginal pressures using the MizCure and Peritron were significantly associated with the supine position (r = 0.68, P < .001) and the standing position (rs = 0.82, P < .001). Conclusion Measurement of PFM strength using the MizCure perineometer is a reliable and valid method in healthy women.

A Mobile Application Penyikang Applied in Postpartum Pelvic Floor Dysfunction: A Cross-Sectional Study to Analyze the Factors Influencing Postpartum Pelvic Floor Muscle Strength and Women’s Participation in Treatment

Objectives. Postpartum pelvic floor muscle (PFM) injuries are the result of pregnancy and delivery, which lead to a series of symptoms requiring long-term follow-up. Mobile health platforms are progressively used for monitoring clinical conditions in medical subjects. This survey was a cross-sectional design based on collecting data from an application (Penyikang). We retrospectively analyzed the risk factors for weak postpartum PFM and further analyzed the factors influencing women’s participation in the treatment which may help to improve the app’s application in the future. Methods. We enrolled postpartum women who gave birth at the Women’s Hospital, Zhejiang University School of Medicine from August to November 2017; trained them to use the app; and collected the demographic and clinical information. This app requires users to fill questionnaires to assess their knowledge of pelvic floor dysfunction (PFD) and pelvic floor muscle training (PFMT) and experience with PFMT, and each therapy evaluation was restored. The relationship between the knowledge of PFMT/PFD, UI symptoms, and PFM strength was analyzed. Cluster analysis was used to define the degree of participation and identify the factors influencing the patients’ participation in intensive therapy and evaluation. Results. 1982 postpartum women who enrolled in the app program were defined as weak PFM. Younger maternal age, cesarean section, and without delivery injury were found as the prognostic factors to PFM strength (both type I and type II muscle fibers) (P<0.05), and higher educational level was also in favor of type II muscle fibers (P<0.05). Patient-reported UI symptoms were associated with weak PFM strength (P<0.05); there were no significant differences between knowledge of PFMT or PDF and PFM strength. Finally, patients with a higher degree of participation were more likely to accept the treatment (P<0.05). Conclusions. The mobile app provides a new applicative way to investigate postpartum PFD. The factors influencing women’s participation can help us focus on strategies to increase the patients’ compliance, and then we will apply the app into more areas to improve the prevention and treatment of postpartum PFD.

The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum

Objective There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12 months postpartum. Methods This study used a prospective cohort design. At 6 weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30 min/wk) were compared with 120 nonexercisers (mean age = 29 years, SD = 4.3). Manometry was used to measure vaginal resting pressure, PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). Results No differences were found between exercisers (n = 57) and non-exercisers (n = 120) at 6 weeks postpartum on vaginal resting pressure (B = −0.04 [95% CI = −3.4 to 2.1]), PFM strength (B = 0.03 [95% CI = −4.7 to 7.4]), PFM endurance (B = −0.02 [95% CI = −59 to 46]), or symptoms of SUI (OR = 0.51 [95% CI = 0.25 to 1.1]) or POP (OR = 0.62 [95% CI = 0.26 to 1.5]) measured at 12 months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and &gt;30 were more likely to report SUI 12 months postpartum (OR = 2.2 [95% CI = 1.0 to 4.7] and OR = 3.3 [95% CI = 1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12 months postpartum (OR = 3.0 [95% CI = 1.2 to 7.3]). Conclusions This study suggests that regular exercise 6 weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. Impact Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6 weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery. Lay Summary First-time mothers are encouraged to talk with a physical therapist about starting regular general exercise in the early postpartum weeks. Health care providers should advise patients on possible preventive measures for women at risk for PFD.

Regression Model for the Prediction of Risk of Pelvic Floor Muscle Weakness among Older Adults

Background Pelvic floor muscle (PFM) weakness is a major cause of pelvic floor dysfunction (PFD) among women. Though PFD is a major disabling condition among institutionalized older women, PFM strength (PFMS) evaluation is not included in regular geriatric assessment because of privacy issues, availability of perineometer, and lack of trained therapists. Hence there is a need to develop an alternative method that can address the issues related to present PFMS evaluation. Methods After obtaining ethical clearance, the institutionalized older women were screened for inclusion criteria and informed consent was taken in this case-control study. PFM strength as a dependent variable was assessed by using the peritron perineometer. Independent variables assessed were age, parity, BMI, menopausal period, abdominal surgical history, core, and peripheral muscle strength, functional comorbidity index consisting of 18 comorbidities and functional mobility. Results One hundred and two institutionalised older women were included in this study. Among the variables considered, age (p = 0.005), years post menopause (p = 0.040), pelvic surgery (p = 0.050), disc disorders (p = 0.047), right hip adductor strength (p = 0.039), left hip adductor strength (p = 0.016), left hip external rotator strength (p = 0.045) and left hip extensor strength (p = 0.017) showed a statistically significant odds ratio (r 2 = 0.484; p ≤ 0.05) and hence they were considered for developing the model. Conclusion A regression model for determining PFM weakness among institutionalized older women has been developed, which may be used as a simple and easy to administer method.

Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial

Hypopressive exercises have emerged as a conservative treatment option for pelvic floor dysfunction (PFD). The aim of this study was to compare the effects of an eight-week hypopressive exercise program to those of an individualized pelvic floor muscle (PFM) training (PFMT) program, and to a combination of both immediately after treatment and at follow-up assessments at 3, 6 and 12 months later. The study was a prospective, single-centre, assessor-blinded, randomised controlled trial. Ninety-four women with PFD were assigned to PFMT (n = 32), hypopressive exercises (n = 31) or both (n = 31). All programs included the same educational component, and instruction about lifestyle interventions and the knack manoeuvre. Primary outcomes were the Pelvic Floor Distress Inventory Short Form (PFDI-20); the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7); PFM strength (manometry and dynamometry) and pelvic floor basal tone (dynamometry). There were no statistically significant differences between groups at baseline, nor after the intervention. Overall, women reduced their symptoms (24.41–30.5 on the PFDI-20); improved their quality of life (14.78–21.49 on the PFIQ-7), improved their PFM strength (8.61–9.32 cmH2O on manometry; 106.2–247.7 g on dynamometry), and increased their pelvic floor basal tone (1.8–22.9 g on dynamometry). These data suggest that individual PFMT, hypopressive exercises and a combination of both interventions significantly reduce PFD symptoms, enhance quality of life, and improve PFM strength and basal tone in women with PFD, both in the short and longer term.