Absolute and Relative Reliability of the Assessment of the Muscle Mechanical Properties of Pelvic Floor Muscles in Women with and without Urinary Incontinence

An analysis of the muscle mechanical properties (MMPs) of the pelvic floor muscles (PFMs) is relevant for understanding the physiopathology of urinary incontinence (UI). However, there is no objective and reliable methodology currently available for quantifying the MMPs of PFMs. Thus, the objective was to determine the intra-rater and inter-rater reliability of the MMPs of PFM assessment with a hand-held tonometer device, called the MyotonPRO, in young women with and without UI. Sociodemographic and pelvic floor questionnaires, plus MMPs of PFMs were assessed in 38 nulliparous women with UI and 40 matched healthy women by two trained physiotherapists on two different occasions, 48–72 h apart. Good to excellent absolute reliability was found for tone, stiffness, and decrement of both intra- and inter-rater analyses in both study groups (Intraclass Correlation Coefficient ranged from 0.75 to 0.92), with a trend of lower values for relaxation and creep. The standard error of measurement (SEM) did not achieve 10% of the mean values for any MMPs. The minimum detectable change (MDC) values were also provided for clinical applications. In conclusion, the relative reliability of tone, stiffness, and the assessment of the decrement of PFMs with MyotonPRO is good to excellent for UI and healthy women. The SEM and MDC values were acceptable for their application in clinical settings.

Urinary Incontinence in Women with Low Back Pain After Post Partum Period

Background: Urinary incontinence is a very common problem in postpartum women. In the literature, about 38 to 43% of postpartum females experience urinary incontinence (UI). Postpartum UI usually occurs due to bladder injury, nerve injury, pelvic floor muscle dysfunction or damage to urethra during delivery. In women having C-section, UI is most probably occurs due to instability of detrusor muscle resulting from vesical denervation. Others risks factors involve in development of UI are fetal factors, operative vaginal delivery and antenatal bladder neck mobility due to pelvic floor muscles (PFM) dysfunction and connective tissue weakness. Lower backache (LBP) is also very common in postpartum females due to joint laxity, weakness of connective tissue, loosening of ligaments and strained abdominal muscles due to enlargement of uterus. There’s a coexisting link between low back pain and UI in postpartum females. Objective: To find association between the severity of urinary incontinence and low back pain in women after postpartum period. Methodology: In this study Quota sampling technique was used. Participants divided into two groups, one group with females having low back pain after postpartum period while other group was having females without low back pain after postpartum period. Participants were provided with questionnaires for urinary incontinence to find out the association between severity of UI and LBP. The questionnaires were self-administered and were provided in English language. Some participants were illiterate, thus questionnaires were filled from them by asking questions verbally. Results: Statistics of ICIQ-UI score was checked by applying Fisher’s exact test, The null hypothesis was not rejected because the p-value was > 0.05, indicating that there was no significant association between UI and LBP in females after their postpartum period Conclusion: It is concluded from this study that there is no significant association found between UI and low back pain in women after postpartum period. Keywords: Postpartum period. Urinary incontinence (UI), Stress urinary incontinence (SUI), Urgency urinary incontinence (UUI), Low back pain (LBP), Pelvic girdle pain (PGP), Pelvic floor muscles (PFM), Pelvic floor dysfunction (PFD)

Evaluation of pelvic floor muscles and sexual function in pregnant women: cross-sectional research

The aim of this study was to evaluate pelvic floor functionality and sexual function in pregnant women. The study was characterized as a descriptive and transversal research. The population consisted of 19 pregnant women, living in Parnaíba/PI. The women's assessment instruments were the evaluation and identification form that contained sociodemographic data, clinical history, obstetric and urogynecological data; the NEW PERFECT scheme was used to assess the functionality of the pelvic floor muscles and the Female Sexual Function Index (FSFI) to assess sexual function. Mean age was 25.95 (± 3.54) years, mean pelvic floor muscle strength was 2.47 (± 1.28); resistance was 4.31 (± 2.99) seconds; the number of repetitions of the contractions maintained was 2.63 (± 1.6) times; and rapid contractions were 5.05 (± 2.87) contractions. Sexual function according to the FSFI totaled a score of 25.61. In this study, it was possible to infer important deficiencies and limitations regarding strength, coordination, control and activation of the pelvic floor muscles. As in the sexual function domain, the FSFI result indicates possible dysfunctions with an emphasis on the hypoactivity of sexual desire.

Stress urinary incontinence in women. Possibilities of conservative therapy

The relevance of this study is due to the high prevalence of stress urinary incontinence in women of different age groups and the search for effective conservative treatment methods. The aim of this study was to present scientific data based on modern evidence on the effectiveness of conservative treatment methods and their safety in the treatment of stress urinary incontinence in women. A review of the literature (original articles, systematic reviews) on the use of conservative therapy for the treatment of stress urinary incontinence in women was carried out. Depending on the severity of stress urinary incontinence in women, their age and concomitant diseases, the options for the proposed treatment may vary. For the conservative treatment of the disease, along with lifestyle modification and the use of hygiene products, it is possible to use training and electromyostimulation of the pelvic floor muscles, innovative laser technologies, and drug therapy. The first line therapy is to train ones pelvic floor muscles. The best effect of the training is observed in younger patients with mild to moderate severity of the disease using stationary biofeedback simulators under the supervision of medical staff. An alternative to this type of treatment is to conduct training of the pelvic floor muscles in the biofeedback mode with portable simulators remotely under the supervision of specially trained personnel. In connection with the coronavirus pandemic, this therapy is gaining wide popularity, as every patient should be offered acceptable and effective treatment options.

Effectiveness of Exercise Interventions on Pelvic Floor Muscle Function of Pregnant and Postpartum Women: A Systematic Review of Reviews

BackgroundDysfunctions related to pelvic floor muscles such as urinary incontinence and pelvic pain are common among pregnant and postpartum women. With properly functioning pelvic floor muscles, it is possible to prevent these dysfunctions. Still, shared understanding about effective exercise interventions is missing. The aim of this review of reviews was to form a summary of the existing evidence about effective exercise interventions on pelvic floor muscle function of pregnant and postpartum women. MethodsNine databases were searched by June 12, 2020. PICO was used to define the eligibility criteria. Population: pregnant or postpartum women, interventions: activity-based interventions aiming to affect the function of pelvic floor muscles, comparators: waiting list or usual care, outcomes: disorders concerning pelvic floors muscles, study design: systematic reviews and meta-analysis. Screening and quality assessment were conducted by two researchers separately. The data were extracted and analyzed narratively. ResultsAltogether 20 systematic reviews reporting findings from 147 original studies were included. The methodological quality of the included reviews was mainly good, overall scores varying from 6/11–11/11. The results showed it may be possible to reduce low-back and pelvic pain as well as the severity of pain with exercise interventions during pregnancy but no association with odds of low back and pelvic pain during the postpartum period were found. With prenatal exercise interventions, it is possible to decrease the risk of urinary incontinence during pregnancy and the postnatal period, but the differences between the control group and the intervention group seem to vanish in the late postnatal period. The results were carefully optimistic within postnatal exercise interventions that decreased pelvic pain, reduction in vaginal bulging and pelvic organ prolapse, but more research is needed. ConclusionsOverall, the level of evidence was low. It seems that with exercise interventions it could be possible to prevent and provide care for the disorders of pelvic floor muscles to some extent. However, more high-quality research is needed to support decision making in the health care systems and to get evidence-based knowledge guiding health professionals working with pregnant and postpartum women.

Electromyographic features of the perineum and pelvic floor in patients with an artificial bladder

Aim – to assess the electromyographic features of the pelvic floor muscles and the sphincter apparatus in patients who underwent radical cystprostatectomy with the formation of an artificial bladder.The main study group consisted of 57 patients with muscle invasive bladder cancer who underwent a standard radical cystprostatectomy with ileocystoplasty. The study of the pelvic floor muscular bioelectric activity with computed electromyography (EMG) of the sphincter apparatus of the pelvic organs was carried out on a 2-channel computer electromyograph "NeuroTrac ™ MyoPlus4". The obtained results of the study of the bioelectric activity of the pelvic floor muscles showed a decrease in the amplitude of contractions in the Work Average mode by 42.1% (p≤0.001) for the perineal electrode, and by 35.7% (p≤0.05) for the rectal electrode, compared with the control group, which indicates a low contractility of the muscular diaphragm of the pelvis and may cause incontinence in patients with an artificial bladder. The average deviation over the entire duration of the session in Work mode in the group of patients with neobladder in channels A and B was 2.3 (p≤0.05) and 1.9 (p≤0.05) times higher, respectively, compared with control group. These data indicate an imbalance in the muscle tone of the pelvic floor in patients after extensive reconstructive intervention on the pelvic organs and can potentiate urodynamic disorders in the study group of patients. The average amplitude (Rest Average) of the activity of biopotentials in the resting state of the pelvic floor muscles along channels A and B is higher by 42.4% and 47.6% (p≤0.05), in comparison with the control group, which indicates insufficient relaxation and rest of striated muscles and sphincter. Despite the change in bioelectric potentials from the rectal electrode in the study group of patients, there were no signs of functional insufficiency of the anal sphincter, in contrast to the severity of urinary incontinence, which correlated and corresponded to the results of bioelectrical changes obtained through channels A and B, up to oscillations and loss of complete control. The EMG analysis of the pelvic floor muscles revealed characteristic changes in the biopotentials of the pelvic sphincters and indicated their relationship with the clinical features of the rehabilitation of this group of patients and the prospect of including the biofeedback method. It is a derivative form of the electromyographic signal in the treatment of incontinence in patients with neobladder.